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Pennsylvania legislation could devastate EMS services: Dean Bollendorf and Don Dereamus

Posted 3/4/20

Pennsylvania lawmakers are attempting to address the practice of out-of-network balance billing commonly referred to as a “surprise medical bill.”

This results when a provider treats …

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Pennsylvania legislation could devastate EMS services: Dean Bollendorf and Don Dereamus

Posted

Pennsylvania lawmakers are attempting to address the practice of out-of-network balance billing commonly referred to as a “surprise medical bill.”

This results when a provider treats you in an emergency situation but that provider is out of the insured’s network. Most emergency medical services agencies meet these criteria due to the uniqueness of our industry or location of the insured when the emergency occurred. 

House Bill 1862 would allow insurance companies to lock in out-of-network provider reimbursements at the insurer’s median in-network rate for emergency care for that region. Locking costs at median in-network rates will dramatically cut the already below-cost reimbursement that emergency medical services agencies see today.

EMS must be exempt from this bill!

The insurance lobby has an unsubstantiated belief that ambulance services are “doing quite well” with the non-negotiable “take it or leave it” in-network payment rates they determine. Concurrently, your state lawmakers are attempting to protect consumers from the “surprise medical bill” issue. Or is it more correctly a “surprise insurance gap” issue caused by unacceptable below-cost in-network rates with high co-pays and deductibles?

Regardless of either assertion, below-cost payments and lawmaker efforts to force those same median in-network payment rates on out-of-network emergency ambulance services will be the final nail in the coffin of our failing EMS system.

Your local ambulance is at the crossroads of a fiscal calamity that is rapidly spiraling into a public safety crisis. This calamity is a result of decades of below-cost payments for service from government programs (Medicare and Medicaid) and insurance companies, which since the Patient Protection and Affordable Care Act, now base their non-negotiable in-network payment rates on those programs.

Since 2002, we are reimbursed using a formula to annually determine payment rates that has absolutely no relationship to the costs of delivering this essential lifesaving, mandated service. Government health insurance program rates were never designed to represent reasonable costs or even cover the provider’s costs but nonetheless our entire reimbursement structure is now based on these payment levels.

The result is your local ambulance service has seen the cost of readiness and response to your emergency rise 55 to 65 percent while payment for services rendered on that call during this same time has only risen 24 percent. No business can sustain such losses and remain viable. Additionally, Medicaid emergency 911 EMS services cost reimbursement should not be based on a “line-item competition” in government budgets!

This is exacerbated by insurance companies that have cost-shifted their responsibility to their own beneficiaries through massive co-pays and deductibles. When patients are receiving out-of-network bills to collect their $100 to $250 co-pay or a bill for the entire amount of the ambulance bill because they have a $6,000 to $10,000 deductible, is it truly a “surprise medical bill” issue, or is it a “surprise insurance gap” issue because insurers lack transparency with their beneficiaries and do not cover a provider’s statutorily mandated reasonably necessary costs?

EMS, like emergency physicians and the emergency department, is the safety net of the American health care system.

We are unique in the health care arena and mandated by law to respond and treat patients in an emergency. We are designated as an essential public service by the state government, yet payment for those services is grossly below the cost to provide the heavily regulated and technically advanced modern prehospital emergency medical treatment and transportation.

Today, the EMS system has fewer EMS services and available ambulances with fewer EMS providers leading to longer response times and a true access to care issue that may culminate in poor patient outcomes and total system failure.

We ask everyone to contact the governor and their state senator and representative to have emergency medical services exempted from any “surprise medical bill” legislation. Please contact them with urgency like your life may depend on it, because it just may.

Dean Bollendorf is president and Don DeReamus is legislative committee chairman of the Ambulance Association of Pennsylvania.