A government advisory panel has put forward solutions to address surprise ambulance bills, including a cap of $100 out-of-pocket cost for patients. They are still debating on how much ambulance services should actually be paid. Concerns have been raised about whether the solution to allow ambulance service providers to set their own rates could lead to increased costs.
Government Advisers Propose Solution to Surprise Ambulance Bills
A government advisory panel has recommended policies for Congress to tackle surprise ambulance bills, including a cap on patient payment at $100 per emergency ride. Current health care reforms have left ground ambulance services largely unprotected, leading to huge out-of-pocket expenses for patients.
The members of the ambulance committee, predominantly from the ground ambulance sector, have suggested policies that enable ambulance providers to set their prices. This has sparked concerns about potential price surges.
Patricia Kelmar, Senior Director for Health Care Campaigns at consumer advocacy group U.S PIRG, supports the $100 cap for emergency ambulance rides as it offers some financial predictability for patients. The committee’s suggestions will be considered by Congress for potential law amendments.
Dealing With Payment Disputes
Payment issues between out-of-network providers and insurance companies currently go through a federal arbitration process. Ambulance disputes are notoriously complex, frequently resulting in patients being pursued for unpaid balances. The system is widely considered inefficient.
As a solution, the committee encourages Congress to consider rate-setting as a more predictable option. In states with existing ambulance surprise billing laws, ambulances and insurers would follow these regulations. If these don’t apply, then payments would be based on either locally set rates or a percentage of Medicare determined by Congress.
Pros and Cons of Rate-Setting Arrangements
The proposed rate-setting arrangements have their drawbacks and benefits. Some experts favor a Medicare benchmark as the simplest solution, even though it may lead to significant upheaval for ambulance providers. For example, ambulance providers in states like Maine, Maryland, Vermont, and Virginia would experience substantial benefits from a higher percentage of Medicare, as the median amounts insurers pay in these states are less than 100% of Medicare.
California to Implement Locally Set Rates
Next year, California will require insurers to pay local out-of-network ambulance rates. Advocacy groups are concerned that costs could rise without defined caps or ceilings. The federal ambulance committee will present its recommendations to Congress early next year, despite the reluctance of key lawmakers to tackle surprise billing due to the potential political fallout.
“We are guaranteeing a payment to our ambulances, which right now is not happening,” said Kelmar, a member of the federal committee.