By Emily White
The Spokesman-Review
SPOKANE, Wash. — The price for ailing Spokane County residents to ride in an ambulance to the hospital has skyrocketed in the past five years.
American Medical Response, the company responsible for 95% of all medical transports in the county, will charge more than $5,000 in most of Spokane County starting next year, a rise of several hundred dollars from this year and thousands of dollars from just a few years ago.
Patients who used an ambulance in the city of Spokane, for instance, will pay a base fee of $5,275 starting June 1 plus $52.49 per mile. That compares to $975 for a ride plus $23.45 per mile they paid in 2021.
It makes Spokane County the most expensive place in the state for an AMR ride, said Spokane County Ambulance Service Board Chair Tom Jenkins. The for-profit company is the largest ambulance provider in the state, according to the Washington Ambulance Association.
AMR is owned by Global Medical Response, a privately held Texas company with 34,000 employees and 7,300 ambulances. It operates in all 50 states and is the largest ambulance company in the country. Among its major investors is Koch Equity Development, an arm of Koch Industries Inc., one of the largest private companies in America.
Amy Link, from GMR public relations, attributed the new cost to price increases that have affected AMR’s ability to maintain its 60 ambulances in Spokane County.
“We recognize that such a significant change can raise questions,” Link wrote to The Spokesman-Review on Wednesday. "... However, healthcare pricing involves a unique set of complexities, and the factors behind these adjustments differ greatly from those in typical consumer markets.”
In Spokane County Fire District 9, which serves Mead and other areas north of the city of Spokane, the ambulance charge will be $5,440 starting next year. That’s up from $2,387 in October 2024. The doubling of rates led the district’s fire commission to start its own ambulance service and end the contract with AMR.
District 9 Chief Matthew Vinci noted that AMR’s base rates don’t even include additional charges for supplies, IV therapies, medication or mileage rates that are applied to ambulance bills.
“This is about access and affordability,” Vinci said. “We have so many stories told to us by people who are afraid they’ll get a big bill, and they stay home and don’t seek care because of that worry.”
Fire District 9 will start its ambulance service in July.
“This is something we should all be worried about — it’s not insignificant,” Vinci said.
Local fire departments negotiated and finalized contracts with AMR in August. In some contracts, local fire departments withdrew their ability to negotiate the price of care in exchange for faster response times and a promise that AMR would begin exceeding the minimum response times required by Washington State Department of Health, Jenkins said. There are 10 fire-based agencies under the Ambulance Service Board.
“If we want them to be on the scene quicker, they have to hire more employees and purchase more ambulances. That costs money,” said Jenkins, who also is the Cheney fire chief.
Jenkins said he and other fire chiefs never would have negotiated that way if the Balance Bill Act hadn’t passed in Washington in 2020. The act protects patients from unwanted medical bills that come after emergency services from out-of-network ambulance providers. The act does not change what patients will pay for in-network care. In other words, the bill protects patients from “surprise billing” or out-of-pocket costs, but it does not make ambulance rides free.
Regardless, some local politicians like state Sen. Marcus Riccelli, D- Spokane, are questioning why those prices need to be so high.
“AMR’s pricing is way out of line,” Riccelli said. “It seems like it’s gouging.”
Riccelli said he wouldn’t be surprised to see other fire districts following in District 9’s lead and creating their own ambulance service so locals don’t have to pay thousands for emergency services.
Spokane City Councilman Zack Zappone said he doubts Spokane would create its own ambulance service through its fire department.
“I haven’t been a part of any conversations where people in Spokane have considered creating our own ambulance district. We’ve got our hands full with our dispatch,” Zappone said. The city of Spokane is working to create its own dispatch system following disagreements with Spokane County over the current regional dispatch.
Spokane Mayor Lisa Brown was surprised by the recent ambulance prices.
“That sounds really tough for families to take on, especially because it’s completely unexpected on a budgeted expense,” Brown said.
Spokane, Spokane Valley and Spokane County Fire District 4 have separate contracts with AMR, Jenkins said. Spokane is responsible for 55% of the 911 calls in Spokane County, Jenkins said.
“This is a private company that has to turn a profit,” Jenkins said. “It has to make sense for them.”
Around 76% of people AMR transports are covered by Medicare or Medicaid, Jenkins said. Around 80-90% of patients who are transported in an AMR ambulance will not see a bill that is near $5,000 after services, Jenkins said.
Ambulance bills from AMR can be covered by insurance for patients who have Medicare or Medicaid, and private insurance holders could benefit from Washington’s balance-billing protections, Link said. In 2023, around 44.7% of Spokane County residents had insurance through their employer, 21.8% had insurance through Medicaid and 12.3% were covered by Medicare. Over 5% of Spokane County residents were uninsured in 2023.
AMR also has a compassionate care program for some patients and uses a fee-for-service model, which means care is not funded through taxes. Fire districts operate on a tax-based system, in which all property owners contribute to emergency medical services.
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