If you have insurance, they usually pay if they cover ambulance. If you have medicare (old people) or medicaid (poor people) they will pay. In a motor vehicle accident, the auto insurance pays. If you are in a car accident that is not your fault or if you are hit by a car, the other person's insurance is supposed to pay. If you don't have insurance the ambulance service will try and collect the money somehow-either have you on a payment plan or put the bill into collections. Many ambulance services eat a ton of cost on transports. Hospitals do, too. Our 25 bed hospital does 5 million dollars in charity care per year. Many volunteer ambulance services (basic life support) will just take what they can get. We have a disproportionate number of patients who qualify for medicaid but don't put in the time to get on the system, for whatever reason. And some ambulance services transport for free. An example would be Maryland State Police air ambulance. They don't charge for transport and are taxpayer funded. They are one of the best flight services in the country, so if you are gonna wrap your car around a tree, do it in Maryland.