Yep, you get an ambulance anyway and then later you get a bill. If you have insurance, they may cover all or part of the amount if it was an actual emergency. If you don't pay your part, someone starts calling you at home and telling you that you need to pay. I suppose if you are A) so broke you don't have a phone or B) homeless, that this is not a problem. Same deal with going to the ER. They have to treat you if you show up regardelss of if you have insurance or not. Medicare or medicade takes care of a few people, some never pay, and the rest of us take up the slack with higher costs. You can't go to jail in the us for being in debt (yet) - the worst that can happen is that your credit gets destroyed. Big deal if it's already bad (or you're homeless). There you go.