Short ambulance ride, big bill
Plus: Applications for arts grants to open; Charlotte's Catholic bishop makes national news; Asbestos in uptown building was first discovered 15 years ago; Winston-Salem's 'Wiener' lights hobby
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A proposal in the state legislature would protect patients from steep ambulance bills. Critics worry it would drive up health care costs — and maybe your insurance premiums
People transported by MEDIC, Mecklenburg’s emergency medical services provider, are routinely charged $1,200 or more, a cost insurance usually doesn’t cover. Some state legislators are trying to prevent surprise ambulance bills.
By Michelle Crouch
Co-published with N.C. Health News
After Cathy Head of Charlotte fell and fractured her shoulder in 2023, she was pleased that her health insurance covered almost all of the expenses for her care: the emergency room visit, the physician’s charges and months of physical therapy. Then she got the ambulance bill.
For a 4.5-mile ride to Novant Health Matthews Medical Center, Head was charged $1,397. Of that, Head’s insurance paid just $130, she said. Another $60 came out of an employer-funded account that helps cover medical costs.
That left Head on the hook for more than $1,000.
The reason? MEDIC, Mecklenburg’s emergency medical services (EMS) provider, wasn’t in-network with her health insurance.
“It was shocking because I pay a lot for insurance, almost $800 a month,” Head said.
In North Carolina and across the country, most EMS agencies are out-of-network for private insurers, leaving patients like Head on the hook for steep ambulance bills — even if they have what they believe is “good” insurance coverage.
Nationally, about 60% of emergency ground ambulance rides are out of network, according to an analysis of 2018-2022 claims by Fair Health, a nonprofit that manages a database of health insurance claims.
It’s a gap in the emergency care system that leaves patients with no control over costs at a moment when they have no choice.
“When you call 911, you don’t get to say, ‘I want an ambulance in my network,’” said N.C. Rep. Donnie Loftis (R-Gastonia). “There are people who call 911 for transport, and then three or four months later get a $3,000 or $4,000 bill.”
Loftis said that’s why he sponsored House Bill 489, which would require insurers to cover ground ambulance rides as in-network. It says patients should pay no more than $100 per ride.
The bill passed the N.C. House in May with unanimous support and is awaiting action from the state Senate.
Ambulance companies tend to stay out of network with insurers because they don’t want to accept the lower rates the insurers offer. And insurers don’t prioritize negotiating with ambulance agencies because there are so many small, local and varied providers, and because patients can’t choose their ambulance in an emergency anyway.
A gap in the federal No Surprises Act
A federal law, the No Surprises Act, is supposed to protect patients from unexpected out-of-network bills for emergency care. Under the law, which went into effect in 2022, patients are required to pay only what they would owe if the care had been in-network.
But the law notably excluded ground ambulance rides.
As a result, ambulance rides are now a leading cause of surprise medical bills and a major driver of medical debt in the U.S., patient advocates say.
To fill the gap, 19 states have approved surprise ambulance bill protections, according to Public Interest Research Group (PIRG), a consumer advocacy nonprofit.
The proposed North Carolina law would require insurance companies to pay the locally approved rate for an ambulance trip. If no local rate exists, it calls for the insurer to pay a minimum of either four times the most recently published Medicare rate or the provider’s billed charge, whichever is less.
To protect patients, the bill limits what they can be charged: no more than $100 or 10% of what the insurer has to pay, whichever is less.
In Charlotte, MEDIC charges $1,194 for most emergency ambulance trips, plus $29 per mile, according to the billing page on its website. Wake County EMS charges between $769 and $1,113, depending on the level of care provided, plus $13.73 per mile.
Critics: N.C. approach will drive up health care costs
Insurers and business groups say they agree with protecting patients from surprise bills but argue that North Carolina’s bill, as written, would drive up health insurance costs by guaranteeing high payments to ambulance providers.
David Smith, who chairs the legislative committee for the North Carolina chapter of the National Association of Benefits and Insurance Professionals, said requiring insurers to pay a minimum of the local rate or four times the Medicaid rate gives ambulance companies no incentive to negotiate.
“If the floor is 400%, then what’s the ceiling?” he said. “I’d rather us say 400% of the Medicare rate is the ceiling. That would establish a reasonable amount of reimbursement and could force everyone to the table.”
Because EMS agencies in North Carolina typically operate without competition, there will be no market pressure to keep prices in check, Smith said.
Ambulance budgets under strain
Rep. Loftis said the minimum reimbursement rates in the legislation ensure ambulance services are paid fairly and can stay in business.
Many EMS agencies operate on thin margins and are struggling to keep up with rising costs, including fuel, equipment and the competitive wages needed to attract and retain emergency medical technicians (EMTs) and paramedics, explained Regina Godette-Crawford, a lobbyist for the North Carolina Association of EMS Administrators.
At the same time, she said, insurers underpay and deny claims, forcing agencies to bill patients directly for the difference. As a result, agencies are often left with high percentages of unpaid bills.
MEDIC budget woes
In Mecklenburg County, MEDIC is under mounting financial pressure, said John Peterson, the agency’s executive director.
“Our ambulances have gotten significantly more expensive. Fuel is more expensive,” he said. “And our No. 1 cost is labor — it’s more expensive because we needed to pay our folks more, gladly and rightfully so.”
He shared the following statistics to illustrate the challenge:
In 2024, the agency had about $27 million in unpaid invoices — nearly a third of its $90 million budget.
About 60% of the people the agency transports are on Medicaid or Medicare, with reimbursement rates so low that Peterson said they don’t even cover the cost of running the ambulance.
Emergency call volume is increasing about 6% every year, driving the need for more ambulances and EMS staff.
To help close the budget gap, MEDIC gets an annual subsidy from Mecklenburg County’s general fund, which is supported by property and sales taxes. The subsidy is expected to remain flat for 2025-2026 at $22.5 million. However, the county budget includes an additional $7.6 million for one-time capital purchases such as new ambulances and equipment.
Peterson said the proposed law “is essential to ensuring EMS providers are fairly reimbursed and that the people we are here to serve aren’t caught in the middle.”
The N.C. legislation wouldn’t change how Medicare or Medicaid pay for ambulance rides — those rates are set by the federal government. It also wouldn’t apply to self-funded insurance plans, which are commonly used by large employers and fall under federal, not state, regulation.
‘It’s a monopoly’
For Head, the $1,000 bill from MEDIC seemed especially excessive because the ambulance crew said they couldn’t do anything about her severe pain on the way to the hospital. Yet she was still charged for a high level of care.
Adding to Head’s frustration, MEDIC’s charges didn’t match what her insurance company’s explanation-of-benefits statement said she should owe: $839, not $1,207.
In an email response to questions, a MEDIC spokeswoman said she couldn’t comment on individual cases. But she said that, generally speaking, the agency charges the same rate regardless of whether a patient receives more advanced life support services or basic care.
She stressed that MEDIC offers charity care and free payment plans and tries to work with patients to pay their bills.
After almost nine months of phone calls and letters, Head said she managed to get her bill reduced to $779. But the experience left her questioning the system.
“The bottom line is, it’s a monopoly,” she said. “When you call 911, you don’t have a choice. There needs to be more competition and a system where ambulance rides are in-network with insurance companies.”
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What to do if you get a surprise ambulance bill
Make sure the bill was sent to your insurer: Sometimes EMS agencies send bills directly to patients without checking whether they have insurance. Call the ambulance company to confirm they have your insurance information and request they submit it to your insurer.
Request an itemized bill: A detailed bill will allow you to see exactly what you’re being charged for. Check it against any published rates on the agency’s website to spot possible overcharges. (Note: Air ambulance rides are covered under the federal No Surprises Act, which means you shouldn’t receive a surprise balance bill for an emergency medical flight.)
Contact your insurance company: Ask your insurer to pay more toward the bill or reprocess it. If you get insurance through your employer, you can also ask your HR department to help negotiate with the provider.
Ask about financial assistance. Many EMS providers offer income-based discounts or zero-interest payment plans. Ask what programs are available and how to apply.
Negotiate. Explain your financial situation to the ambulance company, and ask directly for a discount. Many agencies will reduce the bill if you are willing to make a big payment upfront. Avoid putting your bill on a credit card unless you’re sure you can pay it off.
SOURCE: PIRG
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Michelle Crouch covers health care. If you have tips or ideas for her, please shoot her an email at mcrouch@northcarolinahealthnews.org.
This article is part of a partnership between The Charlotte Ledger and North Carolina Health News to produce original health care reporting focused on the Charlotte area.
➡️ You can support this effort with a tax-free donation. This coverage is supported by readers like you who value smart, transparent and independent reporting.
Today’s supporting sponsor is Landon A. Dunn, attorney-at-law in Matthews:
Long-delayed $2M arts grants finally open for applications June 19
Nearly $2M in arts funding that’s been tied up for almost a year is finally making its way to Charlotte’s grassroots arts organizations and artists. The City of Charlotte announced that applications for Creative Growth Grants will open June 19, distributed by local arts nonprofit Charlotte is Creative.
The money comes from an $11M arts and culture investment approved by the city council last June, with $2M earmarked for individual artists and creative initiatives. But for months, that portion of funding sat untouched as city leaders decided who would manage and distribute the funds, The Ledger reported in February.
In the past, the job has gone to the Arts & Science Council, but after the organization merged with Foundation for the Carolinas, it was unclear who would handle this year’s grassroots grants. The city began seeking applicants to distribute the funding in February and selected Charlotte is Creative from a pool of six. The group will receive $285,000, which is roughly 14% of the total funds, to develop and administer the program.
The Creative Growth Grants will be offered in three categories: operational support for grassroots arts and culture nonprofits, project support for both organizations and individual artists and professional development grants for both. The deadline to apply is Aug. 4 at 5 p.m.
In the future, city arts grants will be administered by a permanent system led by the Foundation for the Carolinas and the Arts & Science Council, which are tasked with implementing Charlotte’s broader Arts and Culture Plan. —Lindsey Banks
Related Ledger articles:
“Plan moves ahead to dole out $2 million in arts funding” (April 30🔒)
“Charlotte’s $2 million arts dilemma” (Feb. 28🔒)
“New twist in Charlotte’s arts funding saga” (June 24, 2022)
Charlotte’s Catholic bishop draws national headlines with his new restrictions on Latin Mass
Catholic Diocese of Charlotte Bishop Michael Martin has been at the center of a flurry of articles in the national Catholic press in recent weeks, stemming from a decision reported last month in The Ledger to restrict the number of churches where the Latin Mass is said to one.
There’s also been backlash from an internal document leaked in which Martin proposed other changes to Catholic Masses in the diocese, not just how many churches allow Mass to be said in Latin.
The Latin Mass, which is a ceremony conducted in Latin and harkens back to Catholic tradition before the Second Vatican Council of the 1960s, has been a heated topic in some Catholic circles. Some believe it signals division among members of the faith and shows dissent with Vatican II reform, while fans of the Latin Mass say it is a more reverent form of worship.
The diocese announced last month that it is spending $700,000 to renovate a chapel on Oakridge Farm Highway in Mooresville, and that Latin Masses would end at four parish churches across the diocese on July 8.
But an article last week in the Catholic News Herald, which is the newspaper and communications website for the Catholic Diocese of Charlotte, said the change has been delayed until Oct. 2 to give “more time for the transition and for renovation of a chapel designated for the Traditional Latin Mass (TLM) community.”
Martin said the changes are meant to implement a 2021 mandate by the late Pope Francis that put limits on the Latin Mass.
Among the national headlines:
An article in last week’s conservative magazine “First Things” says that “Bishop Martin’s proposed norms, drafted before Pope Francis’s death, now read like a relic from a different papal era — an emperor’s-new-clothes moment where the bishop is the last to realize the fashion has changed.”
A piece in America Magazine, a publication produced by the Jesuit order of Catholic priests, said that a leaked draft document showed that Martin considered priests saying Mass with their backs to congregants “not appropriate” and that he was critical of the recitation of a prayer to St. Michael at the end of Mass, which calls on the archangel to help defend against evil spirits. Diocesan officials have said the document was an early draft that has gone through considerable changes in recent months.
The controversy sparked the National Catholic Reporter to publish an article listing “8 things to know about the leader of the Charlotte diocese.” (Among the things to know: Martin was born in Baltimore, he served as leader of the Duke University Catholic Center from 2010 to 2022, and he is well regarded for his homilies.)
—Cristina Bolling
Related Ledger article:
Quotable, Part 1 — 2025: Brooklyn Village developer on the ‘unforeseeable’ discovery of asbestos in old Ed Center building
From a letter sent in April 2025 to Mecklenburg County by The Peebles Corp., the developer of Brooklyn Village, requesting a delay in the timeline for demolishing the old Board of Education building uptown because of the discovery of asbestos, which the developer described as “unforeseeable”:
A Force Majeure Event has occurred with respect to the BOE Demolition (the “BOE Force Majeure Event”), resulting from discovery that the BOE Building located on the Phase II Land owned by the County is heavily contaminated with Hazardous Materials, including approximately 150,000 square feet of asbestos-containing materials. …
The nature and extent of the Hazardous Materials within the BOE Building and the requirement to complete the HazMat Project as identified by the HazMat Survey collectively constitute a Force Majeure Event because the same (a) were (i) unforeseeable, (ii) beyond Phase 1 Developer’s reasonable control, and (iii) not due to Phase 1 Developer’s fault or neglect.
Quotable, Part 2 — 2010: ‘CMS finds asbestos in Ed Center’
From a Nov. 11, 2010, Charlotte Observer article by longtime education reporter Ann Doss Helms, “CMS finds asbestos in Ed Center; Hazmat experts today will size up situation, decide what to do about it”:
Charlotte-Mecklenburg Schools officials have found potentially dangerous asbestos in ceiling tiles at the district’s 47-year-old uptown headquarters.
Hazardous material experts will use today’s Veterans Day holiday to size up the hazard and decide what should be done, Superintendent Peter Gorman said Wednesday. …
Workers found asbestos on the fourth floor this week, when they were running power lines to revamp some of the empty space for cubicles, Gorman said. …
“We are not asbestos experts. We’re bringing asbestos experts in,” Gorman said.
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Related Ledger article:
You might be interested in these Charlotte events
Events submitted by readers to The Ledger’s events board:
TUESDAY: “Coffee with the Chamber,” 8:30-9:30 a.m., at Hyatt Centric South Park Charlotte, 3100 Apex Dr. Join the Charlotte Area Chamber of Commerce for an invigorating morning event that brings together coffee lovers and business professionals from across the Charlotte area. Whether you're a startup founder, a seasoned executive, or just a morning person, this event is the perfect opportunity to brew new connections and spark innovative conversations. Registration required. Free.
THURSDAY: “Professional Development Seminar: Unlock The Power of AI,” 9-11 a.m. at USC Charlotte Regional Site, 200 South College St. Join the Charlotte Area Chamber of Commerce for a dynamic AI certification program, hands-on session designed to help you leverage the power of AI to supercharge your sales performance and productivity. From ChatGPT and CRM integrations to predictive analytics and workflow automation, you’ll discover how today’s smartest tools can help you qualify leads faster, close more deals, and spend more time actually selling. $194.
JUNE 19: “Juneteenth Art Fest,” 4-8 p.m., at Shoppes at University Place, 8931 J M Keynes Dr. Following an exceptional inaugural event, University City Partners is hosting its second annual Juneteenth Art Fest, celebrating art, activism, and African American emancipation. The afternoon will feature minority-owned businesses, local artists, live music, and dance performances along University City’s scenic lakefront. Free.
JUNE 28: “Carolina Farm Feast,” 6-9 p.m., at CFT Market, 511 S. Hoskins Rd., Charlotte. A unique farm-to-table event featuring regional North and South Carolina produce. Friends, supporters, partners and foodies will come together for one of the most unifying human experiences: a meal. $100.
➡️ List your event on the Ledger events board.
In brief:
No bond for Dilworth home explosion suspect: The man accused of blowing up his Dilworth house was ordered held without bond in his first court appearance on Friday. Prosecutors said Michael Edward Barnette, 41, poured gasoline throughout his house on Lombardy Circle on May 2. A neighbor said Barnette “appeared to be having issues selling his house.” (Fox 46)
Homelessness increases: A county survey from January found 444 people experiencing unsheltered homelessness in Mecklenburg, an increase of 16%. Including people living in shelters or other temporary housing, the figure was 2,101, about the same as last year. (Observer)
Investigative reporter to leave: WBTV chief investigative reporter Nick Ochsner, known for following elected officials down hallways and through parking garages on camera to ask pointed questions, is leaving the station to embark “on a new chapter outside of news,” WBTV said on Instagram (hat tip: Charlotte Optimist).
Nonprofit closes: Community Link, a 96-year-old Black-led Charlotte nonprofit focused on housing and economic mobility, will close June 20 due to funding challenges, transferring its core services and leadership to the Ada Jenkins Center in Davidson. (QCity Metro)
Crowds cheer the ‘Winston Weiner’: Winston-Salem residents and visitors are now gathering nightly at midnight to watch the lights turn off atop the city’s iconic Wells Fargo Center, nicknamed the “Winston Wiener.” The attraction has drawn crowds who count down and cheer as the city’s tallest, phallic-shaped skyscraper dims its fluorescent dome. (N.C. Rabbit Hole)