Hidden Costs of Emergency Transport: Mom Faces $100K Bill

Baby’s 15-minute ER flight leads to $100K bill — and the loophole that puts families at risk

Credit: Canva / Motherly

The ambulance billing loophole parents need to know about

By Ruman Baig Updated Aug. 14, 2025

Table of Contents

Every parent has those moments that start out like any other day—until, in a heartbeat, everything shifts.

In October 2022, Jessica Farwell’s 6-month-old son, Brody, suffered second-degree burns when a rice cooker tipped over in their Antioch, California home. She rushed him to the nearest ER, where doctors treated his pain but explained they had no burn unit.

According to ABC7’s 7 On Your Side, staff told Jessica no ground ambulances were available for hours. She offered to drive Brody herself, but doctors refused—he’d been sedated, and the helicopter was already on its way.

What followed was a short air transfer to Sacramento—about 15 minutes—followed by a 0.3-mile ground ambulance ride from the helipad to the hospital entrance. Weeks later, the bills arrived: nearly $90,000 for the airlift and $10,200 for the short ground trip.

The hidden rule that leaves parents with huge bills

Most families assume emergency transport will be covered like other ER care. But there’s a big gap in federal law:

Ground ambulances are not protected by the federal No Surprises Act (NSA). That means if the responding ambulance is out-of-network, you can be balance-billed for the portion your insurer doesn’t pay. Several states add their own protections, but there’s still no national rule for ground transport.
Air ambulances are covered by the NSA’s balance-billing ban, but bills can still be large and disputed while providers and insurers resolve payments—leaving families with confusing statements and collection notices.
Some states, like California, have their own protections for ground transport, but there’s no national standard.

How common is this problem?

About half of emergency ground ambulance rides for people with private insurance involve an out-of-network charge, exposing patients to surprise bills. Studies of large claims sets put the share around 50–55%.
Costs vary wildly by state. In 2022, the allowed in-network amount per mile for ground ambulance mileage was highest in Utah, Wyoming, and California, according to FAIR Health, a major independent claims database.

The rules are shifting—especially in California

Jessica’s case began before California’s new protections took effect. As of January 1, 2024, AB 716 protects Californians in state-regulated plans from surprise ground ambulance bills.

Under AB 716:

The federal No Surprises Act does not prohibit balance billing for out-of-network ground ambulance services, which means you may be billed for the difference between the provider’s charge and your insurance’s payment. However, some states have passed their own laws to protect you from these surprise bills.
Plans must pay the rest at locally set rates (or other specified benchmarks), a design intended to stabilize payments to public and private EMS without billing patients.
The state also publishes allowable maximum rates by county, making costs more transparent.

But the federal NSA still leaves ground ambulances uncovered in most states. Outside California, protections depend on where you live, and even if your state has rules, they might not apply if you’re in a self-funded (ERISA) plan.

Three years of calls—and one breakthrough

Jessica appealed to her insurer repeatedly, citing the laws she thought applied. She requested itemized bills, questioned charges, and tried to get the balances lowered.

For nearly three years, the stress didn’t let up—until she contacted ABC7’s 7 On Your Side. Once the station reached out to the hospital, insurer, and ambulance provider, the remaining balances—more than $100,000—were dropped.

Your action plan for avoiding surprise bills

You can’t control which ambulance shows up, but these steps can limit damage and increase your leverage if a big bill arrives.

Before an emergency

Know your plan’s ambulance coverage. Check whether your insurance covers both ground and air ambulance and how cost sharing works. (DOL’s NSA guide explains what’s covered and what isn’t.)
Identify nearby pediatric specialty centers (e.g., burn or trauma) and your hospital’s transfer protocols. In some regions, transfers almost always involve third-party transport.
Understand your state’s protections. If you’re in California (AB 716) or another state with rules, your rights are stronger; if you’re self-funded (ERISA) in a state with protections, the state law might not apply.

After an emergency

Request an itemized bill and medical necessity documentation. Confirm dates, mileage, level of service, and any “wait time” or “night” surcharges. (Large pricing dispersion is well-documented; errors are common.)
Appeal with your insurer—and escalate. Reference applicable laws (NSA for air; state law like AB 716 for ground). Use your plan’s internal appeal, then external review where available. (CMS has consumer toolkits and a help desk.)
Leverage regulators. In California, the Department of Managed Health Care (DMHC) has directed plans to comply with AB 716 and pay at local rates; file a complaint if needed. Other states have insurance department complaint portals.
Bring in patient advocates. The Patient Advocate Foundation offers free case management for bill disputes and appeals. (CMS also points consumers to PAF.)
Use media or community allies if you hit a wall. As Farwell’s case shows, consumer reporters sometimes get rapid responses. (Her bills were waived after ABC7 intervened.)

Navigating emergency medical bills can feel overwhelming, especially when your child’s health is on the line. Jessica’s experience shows how fast an emergency can turn into a financial crisis. Staying informed, documenting everything, and knowing where to turn for help can make the difference between years of stress and a resolved bill.

Source: