Pa. ambulance services worry proposed fix for surprise bills could put them out of business
Agency representatives said insurance reimbursements would not be enough to break even on operation costs
The Morning Call (Allentown, Pa.)
ALLENTOWN, Pa. — For years, state lawmakers have been unable to agree on how to help consumers with unexpected medical bills from health care providers that are not part of the consumer’s insurance network.
But as lawmakers prepare for a possible vote on their latest proposed fix, a group that generates many of those bills — ambulance companies — says it will suffer if the proposed law is passed.
“Many ambulance services are living on a shoestring," said Larry Wiersch, CEO of South Whitehall Township-based Cetronia Ambulance Corps.
According to Wiersch, the latest proposal in the state House has the potential to shut down ambulance services that are smaller than Cetronia. It has 19 ambulances and a staff of 135.
So-called “surprise medical bills” have been a national issue for years, but no sweeping reform to help consumers has received federal approval.
In Pennsylvania, lawmakers have gone back and forth without a successful resolution since at least 2015.
Insurance companies and the networks of health care providers they create are at the heart of the issue. People who have insurance but get treated by an out-of-network provider — often as a result of an emergency or a situation where it was not obvious the provider was out-of-network — may receive bills for thousands of dollars.
Wiersch said his agency has network agreements with some insurance companies, but not with others.
A typical Advanced Life Support call might cost the agency more than $1,200, according to Wiersch. But a typical reimbursement through an “in network” provider for the same call, Wiersch said, is about $500.
Given the mandatory nature of 911 ambulance work, Wiersch said, EMS providers should be paid directly by insurance companies at a rate that is acceptable to the EMS provider.
Democrat state Rep. Anthony DeLuca of Allegheny County, minority chair of the Insurance Committee, dismissed the objections of the ambulance providers.
If they were exempted from the legislation, DeLuca said, other medical providers that generate out-of-network bills would also seek exemptions.
He said he was aware of funding problems at ambulance companies, but, “You aren’t going to have a perfect bill."
Similarly, Samuel Marshall, president and CEO of the Insurance Federation of Pennsylvania, said his group supported the bill.
It calls for consumers hit with surprise out-of-network bills to be free of responsibility for paying them. Payments would be made by insurers to providers, based on the median figure among in-network payments for that same service in the same geographic area.
If there were money arguments, limited arbitration would be available.
Marshall said insurers do not understand EMS companies’ claims that they could be driven out of business.
“Most ambulance companies are in-network and they are doing quite well,” he said.
In Berks County, Topton EMS runs three ambulances and is the 911 provider in six different municipalities, according to Chief Mike Richards.
The organization struggles to pay the mortgage on its building in Longswamp Township, Richards said. It is not “in network” with any insurance companies, he said, because the insurance companies tend to pay less than half the cost of providing the service.
Financially, Richards said, “We are in crisis.”
Even though more than four years have passed since the debate started, professionals with various roles say consumers continue to be hurt financially.
“One in three Pennsylvanians are hit by surprise balance bills and it is not right,” DeLuca said. “And they are pretty hefty.”
Dr. Mary Stock Keister, a family medicine provider based in Lehigh County and president of the Pennsylvania Academy of Family Physicians, said some of the bills can be “quite large.” Pennsylvania Medical Society President Dr. Lawrence John said finding a solution was “extremely urgent.”
The fact that more than four years have passed without a solution from lawmakers indicates the presence of money, according to George Nation, professor of law and business at Lehigh University.
“Hospitals and doctors have a lot of money and what they do with a lot of that money is lobby politicians. That is the way it works," Nation said. “And insurance companies have a lot of money, too.”
Information provided to The Morning Call by the Pennsylvania Department of State showed there were 72 state-registered lobbyists associated with insurance companies, health care providers or hospital organizations in December.
No lobbyist is employed by the Ambulance Association of Pennsylvania, according to Executive Director Heather Sharar, because the association cannot afford it.
“Lobbyists are expensive,” she said.
Sharar said she urges member companies to talk to their lawmakers. Wiersch said he has communicated with three different Lehigh Valley lawmakers about the issue.
DeLuca said he and state Rep. Tina Pickett (R-Bradford County), majority chair of the Insurance Committee and sponsor of the bill, probably will soon seek a vote by the full House.
©2020 The Morning Call (Allentown, Pa.)