Ambulance providers could recoup more of their billed revenues with direct payment legislation proposed by state Sen. James Seward, R-Milford.
Under current law, health insurance companies aren’t required to issue direct payments for out-of-network ambulance services used by someone they insure. Payments are sent to the insured person, who is supposed to relay the money to the ambulance service, but that money doesn’t always end up where it’s supposed to.
“It’s huge for the medical billing arena,” said Bill Long, CEO of the ambulance and EMS billing company MultiMed, which works for the Saratoga Springs Fire Department.
Long estimated that ambulance providers historically lost out on 5 to 10 percent of their billed revenue by people not paying up. Seward said this setup isn’t fair to ambulance providers.
“They are required to provide these services,” he said. “They can not pick and choose what patients they transport or check their insurance coverage or receive payment at the time of rendering services.”
It’s not clear why patients don’t always pass payments along to the ambulance providers. There is anecdotal evidence that suggests they either treat the money as an unexpected windfall or simply deposit it in the bank.
Currently, health insurers submit direct payments only to ambulance providers in their network. These payments can sometimes be less than what the ambulance provider actually spends to provide its services, which is why they don’t choose to be in the networks of certain insurance companies. Seward said that is an issue that needs to be negotiated between ambulance providers and insurance companies.
He said his proposed solution represented the right role for the state government.
This is an issue that Seward has been working on for a couple years, with the bill reaching the floor of the Assembly recently.
“We’re getting closer to an acceptable arrangement,” he said. “I’m hopeful this is the year we’re going to pull it off.”
Seward is looking for a new Assembly co-sponsor, as the previous one was elevated from his spot as chair of the Assembly’s insurance committee.
The bill has previously been supported by the state’s Volunteer Ambulance and Rescue Association, United New York Ambulance Network and Mohawk Ambulance Services. In a memorandum supporting the proposal in the last legislative session, Mohawk Vice President James P. McPartlon III wrote that the measure would keep money in the health care system.
“In today’s environment it has become increasingly difficult to get patients to pay their ambulance bills,” he wrote. “The majority of these patients fraudulently keep these funds as income and never pay the ambulance service.”
Mohawk serves Albany, Schenectady and Saratoga counties and the city of Troy.
Seward also has a second proposal to fix this problem: A separate bill that would require health insurance companies to issue a joint check to the insured and the ambulance provider, which would require both parties to endorse the check before it could be paid out.