By Christine McConville
The Boston Herald
BOSTON — She couldn’t believe it.
A week after a doctor’s appointment turned into an emergency room visit, the Brookline interior designer was holding a $990 bill from Cataldo Ambulance — for a one-minute ride from Beth Israel Deaconess Medical Center’s east campus to its west campus.
‘I could have walked,’ the woman told the Pulse. ‘But I wasn’t given a choice. I was told, ‘You have to go to the emergency room, and here’s an ambulance.’ ‘
The designer, who requested anonymity because her Crohn’s disease sends her to the hospital a lot, has unwittingly landed at the epicenter of the region’s latest health-care battle.
Insurers are taking on the ambulance companies.
The stakes are huge: Blue Cross Blue Shield of Massachusetts pays out $60 million each year for ambulance rides.
In March, Blue Cross made good on a long-running threat and told ambulance companies to either accept their reimbursement rates, or charge what they want and chase the passengers for the money.
Since then, Blue Cross has been sending checks directly to members, who take rides in those out-of-network ambulance companies.
This passive-aggressive approach, Blue Cross said, is its way of lowering health-care costs by capping runaway ambulance costs.
Ambulance companies ‘are charging outlandish fees simply because they can,’ Blue Cross Senior Director Michael T. Caljouw told state lawmakers last month. ‘They know that private insurers are legally required to pay all fees for emergency services - no matter how high.’
Not true, countered Dennis Cataldo, vice president of family-owned Cataldo Ambulance of Somerville.
Running a 700-employee, around-the-clock business isn’t cheap, he said, and the rates Blue Cross wants to pay won’t cover the company’s costs.
‘If we could collect the same amount on every call, rates would be half, but we have no control over what Medicaid and Medicare pay us, and that’s 50 percent of our business,’ Cataldo said.
‘And we lose money every time a gangbanger gets shot at 3 a.m. We can spend, between manpower and equipment, over $1,000 getting him to the ER, and we never get paid for that.’
So, he said, people with private health insurance wind up paying for other people.
‘Everyone in health care has this problem,’ he said,
The ambulance companies are now backing House Bills 1179 and 1180, which would bar insurers from doing what Blue Cross is now doing - passing the bills on to consumers.
Simply put, ambulance companies don’t want to become bill collectors.
With the state’s other insurers lining up behind Blue Cross, there are no winners or losers yet.
But it should make for a hot summer.
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