State lawmakers from the Rochester area and local ambulance service providers are calling on Gov. Kathy Hochul to sign legislation that would change how insurers pay for ambulance claims.
Under current law, insurers make direct payments to ambulance and emergency medical services providers that are in-network, or “preferred providers.” But when the providers are out of network — which is far more common — the insurers pay their subscribers, who are supposed to use the money to pay the ambulance companies. But the providers say they often get stiffed.
The legislation awaiting Hochul’s signature would require insurers to pay all ambulance claims directly to the agencies, regardless of whether they’re in-network. The state Assembly and Senate unanimously passed the measure this session after supporters had pushed for it for more than five years.
“Oftentimes, what our EMS agents have become is a collection agency,” said Assemblymember Sarah Clark, a co-sponsor of the legislation. “Instead of putting time and resources into what they need to do to deliver health care services and make sure people are safe and healthy and getting the medical treatment they need, they're calling people and tracking down dollars that are owed to them for services provided.”
During a news conference Thursday, Brighton Volunteer Ambulance’s treasurer, Michael Pollock, said the organization has $223,000 in unpaid claims on an average monthly basis.
“We can't go on providing services if we don't have money coming in,” Pollock said. “And it's up to — well, right now, it's up to the governor.”
The New York Health Plan Association, a trade group of health insurers, fought the legislation and argued in a memo that it would increase the cost of ambulance services and health insurance for subscribers.
But ambulance service providers push back on that claim. A memo from the New York State Volunteer Ambulance and Rescue Association in support of the bill said insurance companies have historically used direct payments through in-network contracts to force emergency medical service providers to accept lower reimbursement rates — sometimes as much as 30% lower than how much the service actually cost.
The providers said the law doesn’t deal with payment rates, just how they get paid by insurers.
Jonathan Smith, chief of Pittsford Volunteer Ambulance, said that in every community, people have an expectation that when they have a medical emergency, they can call for an ambulance and get help. Ambulance crews cannot turn down patients, regardless of needs or ability to pay.
“The reimbursement that we receive is critical to our ability to sustain our operation to meet that fundamental expectation that when you call for an ambulance, we're available and ready to respond,” Smith said.
