The thorny question of how much patients should pay for ambulance service is moving through the legislature with competing bills in the House and Senate. So far, there’s agreement on one thing: The current system of “balance billing” or “surprise billing” by insurance companies is broken. 

The two attempts at reform – HB316, which has passed the House, and SB245, which has passed the Senate – concern private insurance payments for “ground-service ambulance,” not helicopter carriers like Life Flight. They establish amounts, directly or indirectly, that insurance firms must pay to reimburse ambulance companies as well as other details such as dealing with out-of-network municipal services.

Importantly, the proposed laws would not affect Medicare or Medicaid payments for ambulance trips, which are set by the federal government. Separate efforts are underway to raise those payments, which often fall far short of the actual cost. The remainder is paid by taxpayers or increased rates on other people covered by private insurance.

The fact that these moves don’t affect federal payments seems like a severe limitation, since only 15% to 25% of ambulance calls in New Hampshire involve private insurance, according to industry estimates. However, those are the trips that can result in unexpected bills that can cost many thousands of dollars, which in turn has generated huge controversy.

Both pieces of legislation will be considered by the other body in the coming weeks.

Ambulances not part of ‘No Surprises Act’

Ambulances have long been the odd-man-out of health care, often sidelined during discussions about medical procedures and payment even as the amount of treatment provided inside the vehicle has increased. For example, ambulances are not covered by a recent state law that aligns with the federal No Surprises Act to reduce the chance of unanticipated medical bills.

New Hampshire is served by a mix of private ambulance companies, of which AMR is by far the largest, and companies owned by the city or town, usually combined with the fire department. Some communities are part of a multi-town emergency service, such as Tilton-Northfield Fire & EMS, which stands for emergency medical services.

Here’s how they differ:

■HB316, which passed the House, is backed by the state Department of Insurance based on a cost study released in January. Although it does not list a specific figure, it would effectively mandate reimbursement by private insurance payments to ambulances of about 200% of the Medicare rate, or else a rate set by the local government.

■SB245, which passed the Senate, mandates private insurers pay for ground ambulance service at 325% of the Medicare rate or a rate set by the local government.

So far, the House version has received the most attention.

That’s partly because of its support by the Insurance Department, which touts a January study by Public Consulting Group LLC that said that each call costs between $414 and $2,317, not including mileage, depending on the level of care and where they take place.

“We hope the study will generate more agreement for providers to come into network so there is certainty for what the provider can expect from commercial insurance carriers,” Insurance Commissioner D.J. Bettencourt told the Concord Monitor in January. “We understand that commercial insurers need to increase their rates. But the ambulance providers need to analyze their current business model and appreciate they have to make reforms to make it more efficient, to make it financially sustainable for the long run.”

However, the plan has drawn opposition from groups including the New Hampshire Fire Chiefs Association, the New Hampshire Municipal Association and the state Ambulance Association. They argue that the study has flaws that greatly underestimate the cost of ambulance service, giving private insurance companies a break and shifting the cost onto others.

They also point to other concerns with the study, including an assumption that EMS agencies will start billing for “treat no transport,” when a 911 call doesn’t end up taking a patient to a hospital. Such a change, they say, would require ambulance personnel to payment information from patients on site instead of counting on hospitals to handle the details, which could deter people from seeking help they need.

These groups largely support the Senate version.

 

David Brooks can be reached at dbrooks@cmonitor.com