Tribune-Star Source | Comments Courtesy of Matt Zavadsky

Lots of YELLOW in this one – shrouded by all the discussions about “surprise billing” (which is actually more appropriately termed “surprise coverage”), insurers are increasingly sending reimbursement for ambulance services to the patient instead of the provider – despite executed assignment of benefits authorizations from the patient. 

This has a significant impact on revenue for ambulance providers and is leading to additional financial hardships for agencies and taxpayers.

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Ambulance providers warn of pending Indiana House bill

It has unintended consequences for patients, maybe even on taxes, they say

By Howard Greninger Tribune-Star

2/16/20

 

https://www.tribstar.com/news/local_news/ambulance-providers-warn-of-pending-indiana-house-bill/article_93a86117-482c-5c73-8170-80087ffb70f9.html

A group that represents ambulance service providers says a bill pending in the Indiana General Assembly could cut their insurance reimbursements and result in layoffs, longer response time and possibly even higher local taxes.

House Bill 1372, heard last week Wednesday before the Senate’s Insurance and Financial Institutions Committee, initially would set all ambulance transportation costs to in-network insurance rates.

That would have the effect of setting rates without the knowledge or agreement of ambulance service providers, the Indiana Emergency Medical Services Association, which represents emergency medical services companies.

“This bill’s original wording was not intended to do what it would end up doing if it [goes through unchanged] … which is to put [the] EMS industry out of business,” said Russell Ferrell, chief executive officer and president of Trans-Care Ambulance, a company that employs 350 people statewide. It is based in Terre Haute and has 40 employees here.

The bill as it stands also could result in cities or counties increasing taxes, Ferrell argued.

“Testimony to the [Senate] committee from Fort Wayne stated it would cost $2.8 million more to that city,” Ferrell said. “That is public-private ambulance service there.”

Nate Metz, president of the Indiana Emergency Medical Services Association, said the issue arose in 2017, when private insurance companies decided to cover only about 30 percent of charged costs with direct payments to ambulance services and then made direct payments to patients for the rest of the benefit.

“Then the patient is responsible and has to wait on a second bill from an ambulance provider…” Metz said. “That tactic significantly delays cash flow to an ambulance provider and turns the patient into a self-pay patient. That creates the perception that patients are getting 100 percent of the bills from ambulance [providers]. We want an assignment of benefit to force [insurance firms] to pay an EMS provider off of our bill and not [pay] the patient.”

Metz said it costs $400,000 to $500,000 a year to operate an ambulance, with ambulance runs costing $285 to $500 per trip. And profit margins are slim, with many ambulance firms operating on a break-even status, he said.

“Our state has lost 12.8 percent of its service providers from 2018 to 2019,” Metz said.

The Senate committee is considering two amendments, one that removes the in-network reimbursement for ambulance services owned by a municipality or an ambulance service that has a contract with a municipality or government agency.

Another amendment would allow a negotiation between ambulance firms and insurance providers, with disputes going to binding arbitration.

Metz said that could be difficult for volunteer organizations because they would have to pay court costs to go to arbitration. Instead, Metz said the issue needs more discussion. Metz said he hopes the ambulance billing language can be removed from the House bill and a revised reimbursement system can be addressed in the 2021 session.

Multiple attempts last week to reach bill author Rep. Martin Carbaugh, R-Fort Wayne, for comment were not successful.

The Senate committee is slated to meet again on the issue Feb. 19, but may not make a decision until the last week of February.

Legislative committees have until Feb. 27 to pass bills to their full chambers. The General Assembly is slated to adjourn March 14.