(Molly Ferguson for Kaiser Health News)

Q: What's a surprise ambulance bill?

When the ambulance service that picks you up is not a member of your health plan's service network, your insurer pays what it considers fair. And then — surprise! — the ambulance service sends you a bill for the balance.

Q: What can I do if I get one of these bills?

●Ask your insurance company to pay more. (United Healthcare says, "We encourage people to first call their insurance company if they are balance billed so they can help determine what additional payment, if any, is owed.")

●Call the ambulance service's billing department. Does that company have a financial-assistance program? Can it offer you a discount or a monthly payment plan?

●File a complaint with your state insurance commissioner's office, state attorney general's office or the Better Business Bureau.

●Ask a consumer advocacy group to help you negotiate the bill down.

Q: Can I avoid these bills ahead of time?

Possibly, if it's not an emergency. First, ask your insurance company: Which ambulance companies are in-network? What do you pay for in-network and out-of-network ambulance rides? If you're on Medicare or Medicaid, you should be protected from surprise bills, though there are exceptions. Here's what to do in two situations:

At the hospital:

If you're at a hospital and need to travel by ambulance to a nursing home or another facility, you may have time to identify an in-network ambulance company. Ask the hospital which ambulance services the hospital works with and whether any take your insurance. Even if the hospital is in your network, don't assume the ambulance will be.

911 calls:

You can't pick which ambulance service responds to an emergency call. But if you want to be proactive, you can figure out the likely scenario where you live.

●Ask your local fire department which ambulance service responds to 911 calls in your town. Is it a government service, a company hired by the government or a combination?

●Ask what the fire department charges, whether it specifies what its ambulance contractors can charge or whether they can send you a surprise bill.

●If a private company serves your area, ask the company what its policies are on surprise billing, also called "balance billing," and what its rates are.

●If there are no local rules protecting you, your state insurance commissioner's office can tell you whether state law protects you from surprise bills. Keep in mind these state protections don't apply if you have a self-funded, employer-sponsored insurance plan, which is common if you work at a large company.

Q: When I call 911, can I choose where the ambulance takes me?

Possibly. Most ambulances will take you to the "closest appropriate facility," but protocols vary from town to town. If you're not in dire condition, the ambulance crew may agree to take you to your preferred hospital. If you're on Medicare, you may have to pay for the extra miles. If you're set on going to a particular hospital, ask if the crew will take you there before you get in.

— Kaiser Health News

Sources: American Ambulance Association; USC-Schaeffer Initiative; Medliminal