By Sarah Roebuck
EMS1
WASHINGTON — Without federal protections, more states are introducing legislation to protect patients from large, unexpected bills associated with EMS transportation.
Surprise bills often stem from the use of ground ambulance services, Axios reports. The introduction of the No Surprises Act at the federal level, along with similar laws in various states, is starting to change how healthcare is delivered in the United States, aiming to ease this burden for patients.
Congress specifically excluded ground ambulance services from the No Surprise Act legislation. Because of this, more states are adopting legislation that would require insurers to cover essential charges associated with EMS transportation.
Washington became the most recent state to introduce legislation to protect patients, PIRG reports.
Washington’s new law will go into effect on Jan. 1, 2025, prohibiting surprise billing for out-of-network ambulance services in emergency situations. This includes both treatment provided at the scene and transportation to a facility for emergency care. Under this law, patients will only be responsible for paying the amount they would within their insurance network. The regulation is specifically for those covered by insurance plans regulated by the state.
Shortly before Washington enacted its legislation, Indiana’s Gov. Eric Holcomb signed legislation that sets guidelines for how health insurance plans compensate ambulance services provided outside of their network, Indiana Public Media reports.
Indiana House Bill 1385 “requires a health plan operator to provide payment to a nonparticipating ambulance service provider for ambulance service provided to a covered individual: (1) at a rate not to exceed the rates set or approved, by contract or ordinance, by the county or municipality in which the ambulance service originated; (2) at the rate of 400% of the published rate for ambulance services established.”
So far, 16 states have signed legislation for protections against surprise ambulance bills. In other states, such as Delaware and Maine, disputes over payments are resolved using an arbitration system, mirroring the approach of the federal law on surprise billing, according to PIRG.
A commission established under the No Surprises Act is preparing to officially present its recommendations to legislators, proposing a limit of $100 on what patients pay for ground ambulance services and suggesting that payments from insurers be tied to rates regulated at the local level, wherever feasible, PBS reports.