The bill mandates that out-of-network ground ambulances be paid 400 percent of the current Medicare rate. The impact of a rate that is four-times greater than Medicare would mean patients with high-deductible plans receive significantly higher bills until they reach their deductibles, and everyone, regardless of their plan, would pay higher premiums to further cover this inflated cost. Costs for consumers would rise further as ambulance service providers go out-of-network to get the government-mandated 400 percent of Medicare reimbursement, as the rate would be substantially higher than current in-network rates.