JOHN YANG: And a medical emergency you want to get to a hospital as quickly as possible.

But what happens when the cost of that transportation is hundreds or thousands of dollars even with insurance.

Ali Rogin has more on how a legal blind spot is creating a dangerous dilemma for families across the country.

ALI ROGIN: When Congress passed the No Surprises Act last year, it got rid of most unexpected billing for out of network emergency room visits.

But the legislation leaped out a crucial service ground ambulance rides.

Every year, roughly 3 million insured people ride in ambulances during medical emergencies.

But up to 85 percent of those transports are out of network.

That means many Americans are being slapped with surprise bills.

Joining me now is Laura Santhanam, NewsHour's digital health reporter.

Laura, thank you so much for joining us.

You spoke to many people who've been affected by this including one California mom, tell me about her experience.

LAURA SANTHANAM: Yeah, so California is one of the worst parts of the country when it comes to out of network billing, or what we call surprise bills.

So this one new mom who I talked to, you know, had a newborn son, her third child last September, shortly after he was born, he developed problems breathing.

And so the hospital worker said you need to take an ambulance, get him to a pediatric facility where they can take better care of him.

So you know, it's an emergency situation, seconds matter.

They did what the professionals told them to do.

After a few days, he recovered, they went home, everything is sort of clicking into place as far as newborns schedules go.

And then a few weeks later, a bill, you know, bills start to show up, right.

You know, the ambulance company is saying that she owes $4,400 for this ride, you know, that was 23 miles to save her son's life.

Presumably, the insurance company's not, you know, paying for it with payments company and the insurance company aren't talking to each other.

She's spending her parental leave when she's recovering and trying to take care of her youngest child, getting these companies to talk to each other so that she's not left with thousands of dollars of medical debt.

ALI ROGIN: And she ended up having to pay several $1,000.

Is that right?

LAURA SANTHANAM: That's right.

You know, so ultimately, after again, you know, like months on the phone, the insurance company agreed to pay for half.

But that left her on the hook for more than $2,000.

She's a teacher.

She didn't have paid leave.

So she ultimately had to cut short her parental leave, go back into the classroom, teach and teach summer school to pay down this debt, that she wasn't looking for her and had no real chance of anticipating in the first place.

ALI ROGIN: Why were ground ambulances not included in the No Surprises Act?

LAURA SANTHANAM: There were a lot of things that the no surprises act tackled, especially thinking about out of network billing.

But when it came to ground ambulance services, it was just a bridge too far, just in large part because the one universal truth it seems about ground ambulances in the U.S. is that it's a complex system.

And it took us decades to get here.

ALI ROGIN: For patients, there's often no way to calculate how much an ambulance ride costs.

Why does the price vary so much state to state?

LAURA SANTHANAM: Part of the complexity is that, you know, in some places, you may have fire departments operating this, you know, there's private equity firms.

And so others hospitals may be running these services, and then you layer on top of that state local taxes on top of that health insurance status and in and out network, and so all of those complications, make it to where it is it no reasonable person can anticipate some of these costs.

ALI ROGIN: I want to talk about something related here, which is a millions of Americans live in what are known as ambulance deserts in which the closest ambulance that they could call is 25 minutes away.

How is this affecting this problem that we're talking about?

LAURA SANTHANAM: It's a problem that came up with this family in California who I talked to, so you know, they had insurance, but in but they're insurance did not cover the one ambulance company that was in the county where they lived and where their son was.

you know, transported like between hospitals.

So that's part of the reason why, you know, when you see things like ambulance deserts, it directly implies that, you know, there are fewer choices.

And when you have fewer choices, you're forced to make decisions that might not be in your best interest.

ALI ROGIN: So in terms of solutions, there are 13 states that have protections against patients being slapped with these emergency ambulance bills.

But on the broader level, we have this committee now in place, what sort of protections are they looking into?

LAURA SANTHANAM: Right.

So they're looking at, you know, what is this, you know, Frankenstein system of ambulatory care that we have right now, and what can be done to fix it?

So, several states have already taken the initiative to protect consumers from some of these surprise bills.

But how sustainable are those solutions?

You know, right now, this committee is, you know, gathering, you know, all kinds of evidence and testimony and research, to try and put together a number of recommendations that they'll then share with lawmakers in Congress and state level and local levels of government to try and see what we can do.

How receptive policymakers will be to those suggestions time will tell but it's definitely a problem worth looking at.

ALI ROGIN: Absolutely.

Laura Santhanam, he's our digital health reporter.

Thank you so much.

LAURA SANTHANAM: Thanks for having me.

JOHN YANG: To read all of Laura's reporting on the high cost of emergency medical transportation, visit our website pbs.org/newshour.