• Why is the hospital sending me a bill for ambulance service?
• Why was I billed $45 for ambulance service?
• Why was I billed $240 for ambulance service?
• What are the Special Exemption categories?
• Who decides if my ambulance use was medically necessary?
• What am I charged if an ambulance arrives to assist me and I decline transportation to the hospital by that ambulance?
• I received transportation by a service that appears to be an ambulance but the bill is substantially larger than the co-payment fees described above. Why?
• I received ambulance service along with another member of my family and both of us were charged the ambulance co-payment fee. Why?
• Does the ministry reimburse the cost of land and/or air ambulance transportation that originates outside of Ontario?

All patients, except those listed in the Special Exemption categories below, who receive land ambulance transportation pay a co-payment for the ambulance services rendered. In most cases, hospitals act as the billing agents although occasionally bills may be issued by the ambulance service provider.

Ontario residents having a valid Ontario health card and receiving ambulance transportation deemed medically necessary are required, under Ontario legislation, to pay the billing institution an ambulance co-payment of $45.00 unless falling into one of the Special Exemption categories listed below.

When an Ontario resident with a valid health card is transported within Ontario by land ambulance, and the receiving hospital physician or designate deems the use of an ambulance medically unnecessary, the ambulance transportation is not insured under the Ontario Health Insurance Act and the patient must pay the billing institution $240.00.

All Ontario citizens who travel within Ontario by ambulance for medically necessary services, and who have a valid Ontario Health Card, are required to pay a portion (co-payment) of the ambulance services rendered in the amount of $45.00, except under the following situations:

• the person receives benefits under the Ontario Works Act, the Ontario Disability Support Program Act or the Family Benefits Act;
• the person receives provincial social assistance (general welfare assistance or family benefits);
• the person is being transferred from one health facility to another for insured, medically necessary treatment;
• the person is enrolled in the ministry's Home Care Program;
• the person is living in one of the following facilities licensed or approved by the Ministry of Health and Long-Term Care:
• nursing home
• home for the aged
• rest home
• home for special care
• home or residence for psychiatric patients.

The receiving hospital's physician (or designate) makes this determination. For the purposes of billing, paramedics are not empowered to determine whether a patient's land ambulance transportation is medically necessary or not.

Patients may decline ambulance transport by requesting to sign a Refusal of Service form provided by the attending paramedics. Patients declining transport by signing the Refusal of Service form are not billed for paramedic services rendered at the scene.

In order to ensure that ambulances remain available to service emergencies, many municipalities utilize third-party non-ambulance medical transport services. Non-ambulance medical transport providers are private firms capable of transporting patients who are not in an emergency situation.

On occasion these non-ambulance service providers may be requested to provide transport for patients and may issue bills that exceed the land ambulance co-payment fee. Concerns regarding such bills should be directed to the provider of the non-ambulance transport service, the hospital arranging for the service, or to the municipality responsible for contracting for service with the non-ambulance provider.

Regulations made under the Health Insurance Act specify that each person transported in an ambulance is responsible for the payment of appropriate ambulance co-payment charge. Therefore each patient transported, regardless of the distance or number of patients in the ambulance, is responsible for the payment of the costs set out in the legislation.

No. Out-of-province or out-of-country air or land ambulance transfers are not an insured benefit under the Health Insurance Act. For more information see OHIP – Ambulance Services Billing

Ontario citizens travelling outside of the province are responsible for the full cost and arrangement of any private medical transfers they require. It is recommended that Ontario citizens travelling outside of the province and/or out-of-country obtain private travel/medical insurance to cover ambulance-related expenses, especially since private medical transportation can be very expensive.