06/02/2026
Understanding Your Ambulance Bill:
Com-Care, Logan County EMS understands that receiving an ambulance bill can be stressful, confusing, and frustrating.
We also understand that an ambulance bill never arrives at a good time. It comes after a 911 call, a serious illness, an injury, a car crash, a hospital transfer, often after the worst day a family can experience. We know ambulance bills can look expensive, especially when patients are already receiving additional bills from hospitals, physicians, specialists, labs, or insurance companies.
Logan County EMS is committed to providing the best possible prehospital care possible and we believe that includes transparency in all that we do, including our billing practices.
We want our community to understand why ambulance services are billed, why the charges may look high, how insurance affects the final balance, and what it actually costs to maintain emergency medical services in this county.
Logan County Ambulance Service is managed by Com-Care Inc., a private company that is contracted via the county fiscal court. This service is subsidized by the county. But what does that mean?
Com-Care supports its operations through the revenue generated by the service it provides. In plain language, EMS is not funded in the same way as other county departments. Ambulance billing is a necessary part of keeping the service staffed, equipped, trained, licensed, insured, and ready to respond. Unfortunately, due to poor insurance reimbursement rates, there is a deficit between revenue and operating cost. This is where the subsidy comes in, it bridges the gap.
It is important to remember that the operating cost is not simply the cost of the ambulance ride itself. It is the cost of making sure an ambulance is available before the emergency ever happens. The budget includes major operating costs such as salaries, overtime, benefits, workers’ compensation, health insurance, medical supplies, equipment repair, fleet costs, billing services, accounting services, insurance, training, utilities, communications, capital equipment, and other required operating expenses.
Logan County’s estimated population is 28,889 people, according to the U.S. Census Bureau data and its citizens need ambulance transport over five thousand times last year alone. Com-Care maintains an ambulance service that is expected to be ready every hour of every day for 911 calls, hospital transfers, highway emergencies, critical care needs, public events, and mutual aid requests.
That is the reality of EMS. The system has to exist BEFORE the emergency happens.
The cost of running an ambulance service includes staffing ambulances 24 hours a day, 7 days a week, 365 days a year. It includes paramedics, EMTs, supervisors, administrative support, employee wages, health insurance, retirement, workers’ compensation, payroll taxes, and other required employment costs. It includes overtime required to maintain coverage during back-to-back calls, hospital transfers, staffing shortages, high call volume, major incidents, and long-distance transports.
It also includes ambulance fleet costs, vehicle maintenance, repairs, equipment rental, fuel, tires, insurance, and future replacement planning. It includes cardiac monitors, stretchers, radios, airway equipment, oxygen equipment, suction units, pumps, medications, IV supplies, bandages, infection-control supplies, disposable medical supplies, and other patient-care equipment.
It includes training, continuing education, certifications, medical direction, licensing, compliance, quality assurance, clinical oversight, billing services, accounting services, software systems, communication systems, utilities, facility costs, and capital planning for future ambulances, medical equipment, and communication systems.
Even when an ambulance is not actively transporting a patient, the cost of readiness still exists. The crew still has to be on duty. The ambulance still has to be maintained. The equipment still has to be checked. The medications still have to be stocked. The radios still have to work. The service still has to be ready for the next emergency. That readiness is one of the largest costs of EMS.
Below is the fee for EMS service here in Logan County. These charges may include the level of service provided, the type of call, patient-loaded mileage, and any additional required resources based on the patient’s condition or the needs of the transport.
Current EMS fees include:
BLS Non-Emergency ​​$405.00
BLS emergency ​​$585.00
ALS Non-Emergency ​​$557.00
ALS Level 1 ​​​$675.00
ALS Level 2 ​​​$930.00
Specialty Care Transport ​$1080.00
Recurrent Lift Assist ​​$50.00
Mileage ​​​$16.00
Initial Lift Assist​​NO Charge
Response Car Backup​​NO Charge
Community Event Standy​NO Charge
Non-Profit Standby​​NO Charge
Fire Operation Standby​NO Charge
It's also important for us to note that Com-Care has one of the lowest fee schedules in Kentucky!
One of the most important things to understand about all this is:
The amount billed is not always the amount paid.
When EMS submits a bill to insurance, the bill reflects the approved charge for the ambulance service provided. The insurance company then processes the claim under that patient’s individual plan. Insurance may apply an allowable amount, deductible, co-pay, coinsurance, out-of-pocket requirement, or denial depending on the patient’s coverage.
An “allowable” amount is the amount the insurance company recognizes for that service. That amount is very often much lower than the amount billed. The patient’s final responsibility depends on their insurance plan, deductible status, co-pay, coinsurance, medical necessity rules, and whether the service is covered.
Com-Care does not set a patient’s deductible. Com-Care does not decide a patient’s co-pay. Com-Care does not decide what an insurance company allows, denies, or applies to patient responsibility. Those decisions are made by the insurance plan.
This is why two patients can receive the same ambulance service and end up with very different financial outcomes. One patient may have already met their deductible. Another may not have. One plan may cover ambulance services differently than another plan. One patient may have commercial insurance, another may have Medicare, and another may have Medicaid.
For commercial insurance, the final balance depends heavily on the individual insurance policy. Some plans have high deductibles. Some require coinsurance. Some apply ambulance services to the deductible first. Some may pay only a contracted or allowable amount. Some may leave a remaining patient responsibility after the claim has been processed.
Com-Care is in network with all the major commercial insurance providers. Many of our competitors cannot say the same. Why does this matter? If an EMS service is not in network then the majority of a bill falls squarely on you, the patient. In short, you pay far more for an ambulance out of you pocket. You subsidize the operating cost instead of passing it on to the insurance company.
For Medicare patients, ambulance services are covered only when Medicare coverage requirements are met. Medicare does not simply pay whatever amount is billed. Medicare applies Medicare rules, Medicare-approved amounts, deductible requirements, and coinsurance. Medicare states that after the Part B deductible is met, the patient generally pays 20% of the Medicare-approved amount for covered ambulance services.
For Medicaid patients, ambulance coverage is handled under state and federal Medicaid rules. Medicaid reimbursement is not based on the full billed charge. It is based on Medicaid coverage requirements and Medicaid payment rules. Kentucky Medicaid states that balance billing for covered services is prohibited and that providers MUST accept the lower assignment as payment in full for covered services.
Medicare and Medicaid are two of EMS’s largest payer groups. That matters because these programs do not reimburse ambulance services based on the full amount billed. They reimburse based on government-set rules and fee schedules.
In simple terms, when EMS bills one dollar, EMS often collects far less than one dollar.
For example, using public Kentucky Medicaid reimbursement information:
A BLS emergency charge is $585. Kentucky Medicaid’s base reimbursement for BLS emergency ambulance service is approximately $82.50. That is about 14 cents for every dollar billed, before mileage or other claim-specific factors. In short, a service loses money on each of these responses and a higher subsidy is required.
An ALS 2 charge is $930. Kentucky Medicaid’s base reimbursement for ALS 2 emergency ambulance service is approximately $110. That is about 12 cents for every dollar billed, before mileage or other claim-specific factors.
Mileage is billed by EMS at $16 per patient-loaded mile. Kentucky Medicaid ambulance mileage reimbursement is approximately $3 per mile, which is about 19 cents for every dollar billed.
Medicare reimbursement is also based on a fee schedule, not the full EMS charge. The Medicare amount can vary by level of service, loaded mileage, and whether the pickup location qualifies as urban, rural, or super-rural. Because of that, there is not one single Medicare “cents per dollar” number that applies to every ambulance bill. However, the same principle applies: Medicare reimburses based on the Medicare-approved amount, not simply the amount billed by EMS.
Commercial insurance may reimburse differently. Some commercial plans pay more than Medicare or Medicaid, but that does not mean they pay the full billed amount. Commercial insurance may still apply deductibles, co-pays, coinsurance, out-of-network rules, medical necessity reviews, or other plan limitations.
Healthcare.gov explains that patient costs may include deductibles, co-payments, coinsurance, and out-of-pocket maximums, depending on the plan.
This is one of the hardest parts of ambulance billing to explain: the charge is the approved fee for the service, but the amount actually collected depends heavily on the payer.
EMS still has to maintain the same level of readiness regardless of the payer. The ambulance must respond the same way whether the patient has Medicare, Medicaid, commercial insurance, no insurance, or a high-deductible plan. The crew still responds. The ambulance still rolls. The equipment still has to be available. The cost of the EMS system still exists.
Com-Care remains committed to providing dependable EMS coverage to the Logan County citizens, visitors, highways, hospitals, communities, and rural areas. That includes emergency 911 response, interfacility transfers, critical care transports, public safety standbys, mutual aid requests, and daily EMS readiness across a large county.
Whether a person lives in Adairville, Auburn, Chandlers, Dot, Dunmor, Keysburg Lewisburg, Olmstead Russellville or anywhere in between, the expectation is the same: when someone calls 911, help needs to be available.
What about when you or a loved one is at a hospital outside the county and need an ambulance to come home or even go to another facility? In many places in the State it is not uncommon to wait many hours or even days for a transport. As a citizen of Logan County, you have an option that many do not. Com-Care will come get you. We regularly go to hospitals outside of our county to bring our people home. We often picked up our citizens in out of county hospitals and transported them to definitive care as well, sometimes several states away. Our dedication to you does not stop at the county line.
We know ambulance bills can be difficult to receive. We know the healthcare billing system is complicated. We know deductibles, co-pays, coinsurance, Medicare rules, Medicaid rules, allowable amounts, and insurance explanations can be confusing and often frustrating.
But we also believe our community deserves to understand what it takes to provide ambulance service, why those services are billed, and how those dollars help keep EMS available in Logan County.
Ambulance billing is not about placing an unnecessary burden on patients. It is about maintaining a county EMS system that is ready when YOU need it most.
Our goal is not just to send a bill. Our goal is to make sure that when someone calls 911, an ambulance is ready to respond.
