San Diego hikes ambulance prices again, as city considers bringing service in-house

San Diego is raising the fees patients get billed for ambulance rides by 18% over the next three years, but City Council members argued Tuesday that insurance companies will pay the hikes — not individual patients.

The hikes, which the council approved unanimously, mean that for five consecutive fiscal years San Diego will have raised ambulance transport rates. The cumulative increase amounts to just under 32.6%.

City officials say the hikes will bring San Diego’s rates up to roughly the county average, raising questions of why the city’s rates had been so much lower than other local agencies.

The increases come with the city’s ambulance service in flux. A 19-month-old partnership with private ambulance companies has been a financial success, but officials say they still might bring ambulance service in-house.

Councilmember Marni von Wilpert said the rate hikes for patient transports are connected to the new partnership and the possibility of bringing ambulance workers in-house — making them city employees, rather than workers for private operators.

Von Wilpert said San Diego officials have no choice but to raise rates because the city’s two private ambulance providers — Falck USA and American Medical Response — are increasing what they charge the city.

The city must pay $4.7 million more to Falck and AMR during the new fiscal year to cover more ambulance hours and to pay Falck and AMR higher hourly rates.

Those increases are a key reason why the city is planning to open up ambulance service to competing providers and considering bringing it in-house — something Los Angeles, San Francisco and Chula Vista have already done.

Von Wilpert said city officials should always be contemplating ways to improve ambulance service, especially with providers raising fees.

“We need to make sure we are doing the most competitive cost containment for our residents and delivering the best service,” she said.

The rate hikes put the city in a stronger financial position to pay ambulance providers more money or to bring the service in-house, which is expected to raise the city’s costs.

Fire Chief Robert Logan said last month that the city plans to start off small and slow with any effort to have the city begin providing its own ambulance service.

That likely means some sort of hybrid approach where city ambulance crews handle low-level emergencies, called basic life support, while private ambulances continue to handle more life-threatening emergencies, called advanced life support.

Von Wilpert said it would be incorrect to say the city is raising patient fees for ambulance transports. “It is only the rates that insurance companies will pay,” she said.

She said that the hikes would affect only an estimated 11% of patients transported by ambulance — those with private insurance.

City officials said people covered by Medi-Cal or Medicare won’t see increases, because those programs cap what they pay for ambulance rates at a fixed rate.

And a state law — AB 716 — says patients who pay directly and uninsured patients get billed at those same fixed rates for MediCal, so they also won’t be affected by this increase.

“No individuals will be on the receiving end of this increase,” said Rebecca Newell, deputy chief of emergency medical services.

Some people with private insurance have co-pays for ambulance transports. It’s not clear whether those might increase.

Von Wilpert conceded that insurance companies could raise their rates for coverage but contended that wouldn’t necessarily be related to the city hiking ambulance transport fees.

“Whether their rates go up is a very complicated process — their rates are going to go up anyway, which is something Sacramento is dealing with,” von Wilpert said.

The hikes went straight to the full council, violating council policy 100-05 and its requirement that fee increases first be discussed by a council committee. The previous hikes, approved in July 2023, also bypassed a committee hearing.

The hikes would bring the cost for the highest level of ambulance transport from $3,151 to $3,717.

©2025 The San Diego Union-Tribune. Visit sandiegouniontribune.com. Distributed by Tribune Content Agency, LLC.