California Ambulance Law Left Gaps for Some Patients
New protections against surprise ambulance bills do not apply to many Californians covered by self-funded employer health plans.
Updated on Sept. 19, 2026 in Financial Planning
Live Poll
Do you trust your health insurance plan to fully cover unexpected emergency medical costs?
While California Assembly Bill 716 prohibited surprise ambulance billing in 2024, the law only applies to state-regulated insurance plans. Patients in self-funded plans remain vulnerable because federal protections under the No Surprises Act do not cover ambulance services.
Why it matters
The gap exists because state laws cannot regulate self-funded health plans, which are governed by federal rules that currently exclude ambulance transport. This creates a significant coverage blind spot for the 75% of large companies that choose to self-fund their employee health benefits.
A patient in Santa Clara County faced a $5,444 total charge, with insurance covering only $927 of the cost. After reprocessing, the patient's out-of-pocket responsibility was lowered to $300, reflecting the complexities of navigating billing disputes outside state law jurisdiction.
The players
Cigna
A health insurance administrator that manages claims for employer-sponsored health plans.
The details
Self-funded plans function differently than traditional insurance because employers directly pay for medical claims while hiring an administrator to manage the paperwork. Because these plans are federally regulated, state-level protections like California's AB 716 cannot mandate how they handle ambulance billing disputes. Patients covered by these plans are not protected by the federal No Surprises Act, which currently omits ground ambulance services from its balance billing restrictions.
Timeline
2024: California law AB 716 took effect.
2025: The patient experienced a medical emergency.
Money Landscape
The introduction of AB 716 in California intended to close the gap left by the federal No Surprises Act for state-regulated plans. However, this development underscores the persistent regulatory divide between state-mandated benefits and self-funded federal plans.
If you receive a surprise ambulance bill, verify whether your employer health plan is self-funded, as this determines your eligibility for state-level protections. Speak with a human resources representative or a financial advisor to understand your plan's specific dispute resolution process.
The takeaway
The major takeaway is that your specific health plan type dictates whether you have legal protection against surprise ground ambulance charges. Review your insurance summary plan description to confirm if your coverage is self-funded, as this defines your options when facing unexpected medical costs.
Further reading
For more on managing medical costs, see Financial Planning.
Source note: This article includes information reported by NBC Bay Area.
Live Poll
Do you trust your health insurance plan to fully cover unexpected emergency medical costs?
