Ambulance Billing

The Ministry of Health pays most of the cost of an ambulance trip for a patient who is injured or very ill. This applies to an air or land ambulance. The patient usually pays $45 of the cost, but there are some exceptions.

Medically necessary trips

The Ministry pays ambulance costs over $45 for:

  • an emergency trip if the attending physician at the hospital signs the ambulance call report after the patient has been admitted.
  • a non-emergency trip if the patient’s doctor states in writing, before the ambulance is used, that the patient’s condition makes an ambulance necessary.

The hospital bills the patient for the $45. When no hospital is involved, the service provider bills the patient.

Air ambulances cost $45 for medically necessary trips. If the patient also needs a land ambulance, $45 is charged only once.

Full costs

The patient must pay $240 for a land ambulance trip when:

  • the trip is not medically necessary or
  • the patient does not have a valid Ontario Health Card or Health 65 Card.

The $240 charge is the average cost of a land ambulance trip in Ontario.

The patient is charged the full cost of any air ambulance flight that is not medically necessary or is not covered by a valid Ontario Health Card or Health 65 Card. The patient must also pay $240 for any land ambulance used.


Some people are fully covered for ambulance services if the trip is medically necessary and the patient could not travel by other means (such as family car, taxi or public transit). The $45 charge does not apply to those who are:

  • receiving provincial social assistance (general welfare assistance or family benefits).
  • transferring from one hospital to another for insured, medically necessary treatment.
  • transferring from hospital to a rehabilitation facility, treatment facility for physically disabled children, medical laboratory or X-ray facility approved by the Ministry of Health.
  • enrolled in the Ministry’s Home Care Program.
  • living in one of the following facilities licensed or approved by the Ministry
    • nursing home
    • home for the aged
    • rest home
    • home for special care
    • home or residence for psychiatric patients.

All those listed exceptions must pay $240 if the ambulance trip is not medically necessary and the patient could have traveled by other means (such as family car, taxi or public transit).

Frequently Asked Questions About Ambulance Billing

Why am I receiving a bill for ambulance service; isn’t the service free?

No. Service is not free, but the majority of your ambulance bill is covered by the Ontario Health Insurance Plan (O.H.I.P.). When transported in a licensed ambulance, Ontario residents receive a bill only for that portion of the bill that is not covered by your health insurance. This fee is normally $45.00.

How much does ambulance service cost?

Normal land ambulance costs are billed at a rate of $240.00, of which all but $45.00 is covered by your Ontario Health Insurance.

I am covered by O.H.I.P., but received a bill for $240.00. Why?

O.H.I.P. insures ambulance transportation only for those trips that are medically essential. The hospital to which you were transported makes the determination as to whether your ambulance trip was medically necessary. If the doctor decides that you could have made your way to hospital by another means, you will be billed for the full amount of the ambulance bill. This is necessary in order to ensure that the system is not abused, and that the service is available to those who really need it.

I am visiting from the United States, or from another country, and am not insured under O.H.I.P. How will I be billed?

Anyone who is not a resident of Ontario, or is not insured under O.H.I.P., will be billed at the full, uninsured rate of $240.00. Some private health insurance carriers and travel insurance carriers may reimburse you for these costs. It is up to you to discuss this with your insurance carrier.

I was visiting from another province when I needed ambulance service. I do have health insurance under my own province’s scheme. Should I be receiving a bill?

Yes. You will be billed at the uninsured rate of $240.00. It is your responsibility to recover any insured costs from your own provincial health insurance plan.

Will I be billed for transfers from one hospital to another?

There is no charge for this service for insured residents of Ontario. Similarly, there is no charge applied when a patient is transferred to a nursing home, home for the aged, or other designated special care facilities.

I am on Home Care. Does this affect whether I receive a bill?

Yes, in some circumstances. Patients being sent home on Home Care will not receive a bill for service, but subsequent calls for ambulance service which are not ordered by your Doctor, will be billed. Whether or not you are responsible for paying these bills should be discussed with Home Care.

When I had my accident, the Paramedics provided first aid care at the scene, but I refused to be taken to hospital. Is there any charge for this service?

There is no charge for this service. You will, however, be required to sign a form releasing Norfolk EMS and its’ employees from any liability arising from your refusal to go to the hospital.