Patients rarely get to choose which ambulance company picks them up, which is why ground ambulance rides have long been a source of surprise bills. California addressed that with Assembly Bill 716, signed on October 8, 2023 and in effect for health plans and policies issued, amended or renewed on or after January 1, 2024.
This guide explains, in plain language, what AB 716 requires, who it protects, the gaps it does not close, and what to do if you receive a ground ambulance bill that seems higher than it should be. It is general information, not legal advice; your health plan and the state regulators listed below can answer questions about your specific coverage.
The short version: If you have a California-regulated health plan, an out-of-network ground ambulance company generally cannot bill you more than your in-network cost-sharing for covered services. If you are uninsured or a self-pay patient, a ground ambulance provider cannot require you to pay more than the Medi-Cal or Medicare fee-for-service amount, whichever is greater. Self-insured employer plans are not covered by these state rules.
What Is a Surprise Ambulance Bill?
A surprise bill, also called a balance bill, happens when a provider that is not in your health plan's network bills you for the difference between its charge and what your plan paid. The federal No Surprises Act protects patients from this for emergency care and for air ambulance services, but, as CMS states, "ground ambulance services aren't covered by billing protections in the No Surprises Act." AB 716 fills part of that gap for Californians in state-regulated coverage.
What AB 716 Does for Insured Patients
For health plans regulated by the Department of Managed Health Care (DMHC) and health insurance policies regulated by the California Department of Insurance (CDI), AB 716 requires that a patient who receives covered services from a noncontracting (out-of-network) ground ambulance provider pay no more than the same cost-sharing they would pay an in-network provider. The law calls this the "in-network cost-sharing amount." In practice:
- You owe only your in-network cost-sharing, such as a copay, coinsurance or deductible amount. The law says an enrollee "shall not owe the noncontracting ground ambulance provider more than the in-network cost-sharing amount."
- Your plan must tell you what you owe. When it pays the ambulance company, the plan must inform you and the provider of your in-network cost-sharing amount and disclose whether your coverage is state-regulated.
- It counts toward your limits. The amount you pay counts toward your deductible and your annual out-of-pocket maximum the same way in-network cost-sharing would.
- The plan pays the ambulance company directly. Where a local government has set or approved an ambulance rate, the plan pays based on that rate, and the plan's payment plus your cost-sharing is payment in full.
What AB 716 Does for Uninsured and Self-Pay Patients
AB 716 also protects uninsured and self-pay patients. Under California Health and Safety Code section 1797.233, a ground ambulance provider "shall not require an uninsured patient or self-pay patient to pay an amount more than the established payment by Medi-Cal or Medicare fee-for-service amount, whichever is greater."
Limits on Collections
The law, as amended by SB 1061 effective January 1, 2025, also limits collections. For insured patients, these limits apply to out-of-network ground ambulance providers billing people in state-regulated plans; for uninsured and self-pay patients, they apply to any ground ambulance provider:
- A provider may send to collections only the amount the patient actually owes under the law (the in-network cost-sharing amount for insured patients, or the Medicare or Medi-Cal amount for uninsured or self-pay patients).
- A provider, or anyone collecting on its behalf, may not report adverse information to a consumer credit reporting agency.
- A provider may not sue the patient for at least 12 months after the initial billing.
- A provider may not use wage garnishment or liens on a primary residence to collect.
Does AB 716 Cover Non-Emergency Ambulance Rides?
The law refers to "covered services" from a noncontracting ground ambulance provider and is not written only for 911 emergencies. Analysts read it to include non-emergency ambulance transport: a Commonwealth Fund map of state laws prepared by Georgetown University researchers notes for California that "Non-emergency transport is included in protections." In its June 2024 guidance to health plans, which replaced earlier DMHC guidance on non-emergency ground ambulance rides, the DMHC said AB 716 "broadened the enrollee protections against balance billing for noncontracted ground ambulance services." AB 716 applies to ground ambulance providers; it does not address wheelchair van or stretcher van rides.
Who AB 716 Does Not Cover
- Self-insured (self-funded) employer plans. The DMHC explains that coverage not subject to state regulation "includes coverage provided by a self-insured employer that is administered by a California-licensed health plan." The Commonwealth Fund notes that self-funded employer plans "cover most U.S. workers," so check with your employer or plan.
- Medi-Cal managed care plans are excluded from the AB 716 cost-sharing section, but Medi-Cal members already have separate protection: under Welfare and Institutions Code section 14019.4, a provider that has a member's proof of Medi-Cal eligibility may not seek payment from the member for Medi-Cal-covered services, and AB 716 keeps that protection in place.
- Medicare Advantage products are outside the scope of the DMHC's AB 716 guidance to health plans, which states that it "does not apply to Medi-Cal managed care products, Medicare Advantage products, or specialized health care service plan products." For Medicare ambulance rules, see our guide to Medicare coverage for ambulance transport.
How to tell which rules apply: Under AB 716, your plan must disclose whether your coverage is regulated by the state when it pays an out-of-network ambulance claim. If you are not sure what kind of plan you have, ask your plan or your employer's benefits office.
California Compared With Other States
California is one of a growing number of states with ground ambulance protections. In February 2026, researchers writing for the Commonwealth Fund reported that people in 22 states now have some protection from surprise ground ambulance bills, and that 13 of those states cover non-emergency transportation as well as emergency services. At the federal level, a federal advisory committee issued recommendations on ground ambulance balance billing in 2024, but the same researchers wrote that "federal action has stalled."
What to Do If You Get a Bill You Think Breaks the Rules
- Find out what kind of coverage you have. Check your plan documents or the explanation of benefits for whether the plan is state-regulated.
- Compare the bill with the payment notice or explanation of benefits your plan sends. If you have state-regulated coverage and the ride was a covered service, the amount you owe should match your in-network cost-sharing.
- Call the ambulance company's billing office and ask for an itemized bill and a correction if the amount is higher than the law allows.
- File a grievance with your health plan. The DMHC advises members who believe they were illegally balance billed to file a complaint, also called a grievance, with their plan first.
- Contact the state regulator if it is not resolved. If the plan does not fix the problem or takes more than 30 days, the DMHC says to contact its Help Center at 1-888-466-2219 or DMHC.ca.gov. For health insurance policies regulated by the Department of Insurance, call the CDI consumer line at 1-800-927-4357.
For more on paying a ground ambulance bill and your options, see our guide on how to pay an ambulance bill, and for typical costs, how much an ambulance ride costs in California.
How West Coast Ambulance Can Help
West Coast Ambulance provides BLS ambulance and critical care transport in Los Angeles and Orange Counties, and wheelchair and stretcher transportation across Los Angeles, Orange and Kern Counties. Before a scheduled trip, our team can check your insurance benefits for free so you know what to expect. Rides booked with us directly or online are private pay, and Medicare and Medi-Cal may cover BLS ambulance transport when it is medically necessary and authorized. For billing questions, our billing team can be reached at 800-880-0556 or [email protected]; see our Insurance & Billing page for details.
Frequently Asked Questions
What is California AB 716?
AB 716 is a California law, signed October 8, 2023, that protects patients from surprise ground ambulance bills. For state-regulated health plans and policies issued, amended or renewed on or after January 1, 2024, a patient who receives covered services from an out-of-network ground ambulance provider generally owes only their in-network cost-sharing. It also caps what uninsured and self-pay patients can be required to pay.
How much can an ambulance charge an uninsured patient in California?
Under California Health and Safety Code section 1797.233, added by AB 716, a ground ambulance provider cannot require an uninsured or self-pay patient to pay more than the established Medi-Cal or Medicare fee-for-service payment amount, whichever is greater.
Does AB 716 apply to my employer health plan?
Only if the plan is regulated by the state of California. AB 716 applies to plans regulated by the Department of Managed Health Care and policies regulated by the Department of Insurance. The DMHC explains that coverage provided by a self-insured employer is not subject to state regulation, even when a California-licensed health plan administers it.
Does the No Surprises Act cover ground ambulances?
No. CMS states that ground ambulance services are not covered by billing protections in the federal No Surprises Act, which does protect patients for air ambulance services. California's AB 716 provides state protections for ground ambulance rides for people in state-regulated coverage and for uninsured and self-pay patients.
Can an ambulance company report my bill to a credit bureau in California?
Under the law as amended by SB 1061, effective January 1, 2025, a ground ambulance provider, or an entity acting on its behalf, may not report adverse information to a consumer credit reporting agency for amounts covered by these protections, may not sue for at least 12 months after the initial billing, and may not use wage garnishment or liens on a primary residence to collect.
Who do I contact about a surprise ambulance bill in California?
Start with the ambulance company's billing office and your health plan's grievance process. If your plan does not resolve it, or takes more than 30 days, contact the DMHC Help Center at 1-888-466-2219. For health insurance policies regulated by the California Department of Insurance, call 1-800-927-4357.
Sources
- California Legislature, AB 716 (2023), Chapter 454; current text of Health and Safety Code 1371.56, Health and Safety Code 1797.233 and Insurance Code 10126.66 (accessed November 3, 2026)
- California Legislature, SB 1061 (2024), Chapter 520; Welfare and Institutions Code 14019.4
- Department of Managed Health Care, All Plan Letter 24-010 (June 13, 2024), press release (June 13, 2024) and File a Complaint
- California Department of Insurance, Consumer help
- CMS, Know your medical bill rights when using insurance (October 1, 2026) and Advisory Committee on Ground Ambulance and Patient Billing
- Commonwealth Fund, Consumers Still Face Surprise Bills for Ground Ambulances — States Are Trying to Protect Them (February 18, 2026) and state ground ambulance protections map