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By NerdWallet Health health finance expert Christina LaMontagne


My husband suffered a heart attack when we were on vacation, and I had to call an ambulance. He’s OK now, but we’ve been billed more than $6,000 for his 15-minute ride to the hospital. As it turns out, the ambulance service wasn’t in our health insurer’s network, so they paid only a small portion of the bill. We’re making small payments on the balance, but the initial bill seems so high. The collector calls all the time to demand we pay the balance in full. Is there anything we can do to get the bill looked at and possibly lowered?


I’m glad to hear your husband is recovering, but I am sure the stress of an unexpected medical bill isn’t helping him heal. Ambulance bills are notoriously costly, but yours seems to be inflated. Fortunately, medical bills are not always set in stone, and there may be ways for you to negotiate a lower balance.

I recommend you first review an itemized copy of the bill for any errors. Look for duplicate charges, inaccurate service dates or incorrect mileage. If you spot any errors, take it up with the billing department immediately.

Even if the bill is correct, you should still set up a time to speak with someone in the billing office—someone with the authority to negotiate on your balance. Go into the conversation equipped with the knowledge that Medicare and insurance companies rarely pay the hefty price tags that consumers see. Standard practice for insurers is to negotiate with providers to pay merely a fraction of the cost. In the case of inpatient hospital bills, for example, a NerdWallet study found Medicare negotiates, on average, a 73% discount. While the ambulance service may not agree to such a large discount for you, coming to any negotiation equipped with such knowledge will put the company on notice that you aren’t going to lay down and take its bullying or an inflated bill.

Consider how much you are able to pay. If the ambulance service isn’t willing to deduct a good portion of the original bill, think about how much is fair and reasonable for the service your husband received and your budget. Negotiating a lower balance, even if you can’t pay it off in a lump sum, will remove a considerable burden from your shoulders. It may even benefit the ambulance company, which might fear receiving no payment from you at all, since the majority of bills in collections are never paid off. If you do set up a formal payment agreement, make sure to get it in writing.

Negotiating with an ambulance service or any medical provider is not easy, but it is possible. Be persistent. If your efforts prove fruitless, you can always consider hiring a professional. A medical billing advocate is able to represent clients’ interests much in the way an attorney would advocate for you in a courtroom. Their experience and expertise in the field can sometimes prove more effective (and less stressful) than taking on a stubborn provider alone.