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Unfortunately, health insurance premiums continue to rise regardless of whether or not a community decides to bill for EMS transports. Such factors as prescription drug coverage, litigation, technology improvements in the medical field and depressed insurance company investment returns have resulted in escalating health insurance premium costs. However, ambulance transport costs represent less than 1% of health care expenditures. Many other local governments in Virginia have implemented a revenue recovery program for ambulance transport fees, and they have reported no evidence that EMS billing increases health insurance premiums.