For a year and a half now, the No Surprises Act has protected patients from some of the most outrageous out-of-network medical bills. But Congress left something pretty crucial out of the law — bills from ground ambulances.

We look at just how wild ambulance bills can be, with a story about three siblings who took identical ambulance rides — from the same car wreck to the same hospital — and got completely different bills. (Thanks to Bram Sable-Smith who reported the story for the Bill of the Month, a series from NPR and KFF Health News.).

And we find out how ambulance bills ended up being so random — a story that takes us back to the 1970’s.

Plus, what you can do if you get hit with an out-of-network ambulance bill:

• See if you can negotiate a better deal
• See if you might qualify for financial assistance. (Here’s some detailed guidance from Jared Walker of Dollar For.)
• See if you’re protected under state law. At least ten states have passed laws protecting some patients from surprise ambulance bills. Check here to see if yours is one of them.

Want to share your thoughts on how Congress should deal with out-of-network ambulance bills? A federal advisory committee wants to hear them. You can email them here.

Here’s a transcript of this episode.

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