Manitoba is home to the highest ambulance fees in the country, a survey by CBC's Marketplace shows, but comparing rates depends on a complex set of factors.

The Assiniboine area of Manitoba's Prairie Mountain health region has the highest flat rate ambulance fees in all of Canada. (B Calkins/Shutterstock) The Prairie Mountain Health region has the highest flat-rate in Canada for its Assiniboine area, where the fee is $530.

In Winnipeg, the fee is not far behind at $512. And if you take an ambulance in Winnipeg but live outside of Manitoba, you pay $818.

Winnipeg musician Dustin Harder has felt the sting of an unwelcome ambulance bill.

Harder told CBC News a stranger assaulted him and knocked him unconscious in 2012 and someone else called an ambulance. He said he didn’t want to go by ambulance but was taken anyway.

"I said, 'No, I don’t want the ambulance bill — I can’t afford it,’" Harder said, explaining he was struggling financially at the time.

By comparison, most Canadian provinces charge less than $200 per trip, except when trips are unusually long or if the call is deemed not medically necessary. In New Brunswick, trips are free if the passenger doesn’t otherwise have insurance.

In Ontario, an ambulance costs $45 unless the trip is considered not medically necessary.

Alberta charges the same rate across the province: $385 if you’re taken to hospital and $250 if the patient is treated at the scene.

Depend on subsidies

In Manitoba’s Prairie Mountain region, a manager for emergency medical services Louise Stitt told CBC News she was not aware the $530 charged in the Assiniboine area of her region was the highest flat rate in the country.

The Manitoba Regional Health Authority (RHA) is comprised of five regions, including: the Northern RHA, Prairie Mountain Health RHA, Interlake-Eastern RHA, Southern RHA and Winnipeg RHA (which includes Churchill). (Manitoba Regional Health Authority)

But Stitt said fees differ between provinces and cities because they depend on the subsidies provided by the different provinces and municipalities.

"To quote rates in such a complex system is really difficult to compare because I don’t think it’s comparing apples to apples," Stitt said.

She also said some regions may charge a lower flat rate than Assiniboine’s but then add on other fees that push the patient’s total bill much higher.

There have been rare occasions where they have decided not to go by ambulance because of the cost. - Wayne Chacun, MGEU

Those extras include a fee per kilometre travelled, non-residency fees if you live outside the local health region, or a fee for advanced life support technology for some patients.

Stitt said a flat fee without an extra mileage charge is fairer in a rural area because mileage fees penalize those who live furthest from the hospital.

Harder never paid

In Harder’s case, he was told the province’s Victims Services Branch could help him with the cost since he was a victim of a crime.

Dustin Harder was slapped with an ambulance bill after being physically assaulted. He says he didn't request the ambulance and didn't want to use the service. He never paid the bill and the city eventually sent his case to a collection agency. (CBC) He gave up after several calls to the branch yielded no results.

He never paid the bill and the City of Winnipeg eventually sent it to a collection agency.

"Here’s a collections agency because of an ambulance ride that I didn't choose to take," said Harder.

He said people shouldn’t be put in a position of having to decide whether or not they can afford an ambulance.

"What if they decide 'no, I can't afford it’ and they don't go, and something is seriously wrong and they do have a heart attack and die because they can't afford the service," Harder said.

Harder not alone

Harder is far from alone in having an unpaid ambulance bill in Winnipeg.

The Assiniboine Regional Health Authority comprises the southwest corner of Manitoba. (Assiniboine Regional Health Authority ) In 2014, the city billed patients for 45,500 emergency trips at a total of $22.2 million.

A city spokesperson said there are currently 13,500 invoices that are past 90 days, adding up to $6.4 million.

The funding model in Winnipeg requires patient revenue to cover half the cost of the emergency medical service while the regional health authority and the city pay 25 per cent each.

Any remaining city costs are funded by property tax.

The underlying intent is to create a user-pay approach to ambulance funding as opposed to a fully tax funded service, the city spokesperson said.

Cost deters patients in need: Paramedic

But a veteran paramedic told CBC News he’s witnessed patients debating whether they can afford the service.

"Quite often they're just weighing the cost — 'Am I able to afford this?'" said Wayne Chacun, a vice president with the Manitoba Government Employees Union, which represents paramedics.

"There have been rare occasions where they have decided not to go by ambulance because of the cost," Chacun said.

"If you need an ambulance, you should take an ambulance. That's always my message," said Chacun.

Marketplace investigated the toll that ambulance fees take on Canadian patients. Watch No Free Ride, Friday at 8 p.m. (8:30 p.m. NT) on CBC Television or online.