Ambulance operators often have a hard time recouping the costs of an emergency run. A new Pennsylvania law attempts to solve the problem, but many rescue squads say it doesn’t go far enough.
As of Jan. 1, emergency responders can directly bill insurance companies instead of having to request payment from out-of-network patients, who typically receive a check from their insurance companies for the ride.
“Many either don’t know what to do with a check, or they cash the check,” said Timothy Hinchcliff, managing director of Burholme EMS in Philadelphia and a board member of the Pennsylvania Ambulance Association. “Thousands of dollars are lost each year as insurance payments are not properly sent from the patient to the provider.”
With the new legislation, ambulance companies can avoid nagging patients to pay up. But If they go the direct billing route, they can’t ask for any more money from patients, and the reimbursement can be at a lower in-network rate.
Hinchcliff said that’s a problem because for many units, it’s just not enough to cover the costs.
“It’s not unusual for the insurance companies to pay below a Medicare rate,” he said. “The average ambulance trip can run more than $400 per trip.”
For Hinchcliff, who backed the legislation and calls it an important, if incremental, step forward, it makes sense for his urban unit to take the direct payments. But many suburban squads have come to the opposite conclusion.
Thomas Topley, chief of the Bensalem Rescue Squad, said he lost $60,000 last year to people who kept their insurance checks. But he’d likely lose even more if he took the reduced in-network rates.
“We’re losing $50 every time we start the ambulance to go out the door to help somebody,” he said.
Samuel Marshall of Insurance Federation of Pennsylvania said the larger complaint should be with the low rates the government pays.
“The truth of it is we pay significantly more than Medicare and one heck of a lot more than Medicaid,” he said, speaking for private insurers. “It’s not that we don’t cover their costs for what they do for us.”
For insurers, an important part of the law was the promise that ambulance providers would not be able to collect more funds from patients beyond an allowed co-payment or co-insurance.
“We need to make sure our policyholder is not gouged,” Marshall said.
Hinchcliff and Marshall called the law a compromise. But Topley said it doesn’t help his unit at all.
“If the ambulances don’t get relief from Pennsylvania, they’re going to go out of business,” he said. “There’s many ambulances in Bucks County right now struggling to stay afloat, and we could see reduced service to the residents of Bucks County if something’s not done.”