Written by Leslie Bonilla Muniz Indiana Capital Chronicle
February 15, 2024
Do you need an ambulance? Some Hoosiers may be out of luck.
Despite an increase in 911 calls in the state since 2018, multiple independent emergency medical services (EMS) providers have closed and hundreds of paramedics, emergency medical technicians (EMTs), and ambulance have lost.
EMS providers say insurance stinginess complicates their financial stability, forcing Hoosiers to unknowingly hand over large bills. They are looking to enact legislation that would force health plans to pay for transportation to out-of-network providers.
But companies say House Bill 1385 This will have a significant impact on small and medium-sized employers, forcing them to pass costs on to their employees and customers.
Wednesday’s nearly two-hour debate drew a lot of criticism from experts and lawmakers alike.
This has led Sen. Fadi Kadura (D-Indianapolis) to call the issue a “classic” example of the triple theory of failure: by government, by the for-profit market, and by the nonprofit sector.
The Senate bill’s sponsor, Sen. Tyler Johnson, a physician, said he has heard from people across the state who are receiving “unbelievable bills” of $10,000 or $15,000. He called it “unacceptable.”
“We believe we’ve developed a product here that will stabilize this industry so that an ambulance comes when you need it and you don’t get a surprise bill at the end of the day.” Johnson , Republican, said about the bill with Leo.
The committee voted 7-1 to move the bill to the full Senate. Sen. Mike Gaskill (R-Pendleton) voted no.
Long wait times and legislative solutions
According to 2023 statistics, half of Indiana’s 92 counties have “ambulance deserts,” where residents live more than 25 minutes from an ambulance station. study By the federally funded Center for Rural Health Research and Policy.
Indiana data shows the state lost 300 paramedics, 1,000 EMTs, 200 ambulances and several health care providers between 2018 and 2021. Transport volume during this period increased by 66% to more than 1.25 million people.
Brian Burdick, a partner at Burns & Thornburgh who represents the Indiana EMS Association, told lawmakers there are only three types of insurance: government insurance such as Medicare and Medicaid, private insurance, and insurance for everyday needs. He said it should be pulled. Someone has to pay the bill.
The bill would require health plan providers to pay out-of-network ambulance service providers a fee set by the county or municipality that initiated the transportation. If there is no local rate, the plan administrator must pay his 400% of the published Medicare base rate or the rate charged by the ambulance provider, whichever is lower.
According to the fiscal report, Medicaid rates in 2023 were approximately $266, depending on mileage charges. analysis.
If your health plan pays, your bill will be paid in full in addition to any copayments or deductibles that are equivalent to what in-network patients pay. In that case, the bill would prohibit ambulance providers from billing patients.
The law also eliminates the requirement that health plan operators negotiate with ambulance providers interested in in-network status.
Lawmakers passed an amendment Wednesday that would remove state employee health plans from the bill’s requirements. Committee chairman Sen. Scott Baldwin (R-Noblesville) said the change was made to avoid changes to state finances because it is a non-budget session.
EMS providers say they’re on the precipice
Kim Godden, director of government relations for Illinois-based Advanced Emergency Services, said billing patients embarrasses them.
“The person who calls the ambulance has already had a bad day. They expect their insurance company to cover the cost of the ambulance ride,” she said. “…Then when it came time for us to bill them, they called and said, ‘Why isn’t this covered?’ And why aren’t we on-network? ? ”
She added that for out-of-network rides, the insurance company may send the check to the patient rather than the ambulance provider. Often, when a provider comes knocking, the money has already been spent.
“We are here to serve. We are here to provide care, regardless of someone’s ability to pay. But when you try to bill individuals on the back end, they It’s confusing,” Godden said.
Joel Benz, executive director of Three Rivers Emergency Department in Fort Wayne, said he spent $800,000 on claims last year “trying to corner money that was owed to us.”
If the insurance company pays the ambulance provider directly, the payment may not match the cost of providing the service.
Bentz said it costs his company $633 each time a patient is taken to the hospital, and called the bill “a demand to recoup what is owed to us.”
Just this week, a private insurance company offered to pay $200 on a $2,500 bill, said Justin Ferrell, chief operations officer for Terre Haute-based Transcare Ambulance Company.
“They provide fewer services than Medicare and Medicaid,” he noted. These government health insurance programs are notorious for having low reimbursement rates.
Meanwhile, he said, ambulance supplies are becoming more expensive. Stretchers cost $25,000 each, heart monitors cost $40,000, and other supplies cost an additional $20,000 to $40,000. When you add in wages, benefits, insurance and building lease gas, expenses are skyrocketing, Ferrell said, reaching into the 20,000-gallon-a-month range.
The bill’s author, Rep. Brad Barrett, likens coverage to shrinkflation at a grocery store.
“You buy a box of cereal for two years, and one day you go and pick it up and it’s half full. It’s the same box,” Barrett, R-Richmond, said Wednesday. “And that’s what happened with the insurance products we offer our employees. This is carved out. The federal government can’t solve it, but as a state we can address it. I can.”
Companies are concerned about rising insurance premiums and inequity
But those who pay premiums argued that the bill would hurt them unless it addressed the root causes of the funding crisis.
Under federal law, states can only regulate a small portion of insurance plans, those most likely owned by small businesses.
Natalie Robinson, the national federation’s Indiana state director, said, “While we sympathize with the financial hardship and crisis the lifeguard industry is experiencing, we are against House Bill 1385 because of the increased costs that will burden small business owners. I respectfully oppose it.” of an independent business.
She argued that the bill could actually increase health care costs by raising premiums, which businesses would pass on to employees and customers. She said companies are already grappling with rising insurance premiums and inflation, as well as labor shortages due to higher salaries.
Andrew Berger, executive vice president of government affairs for the Indiana Manufacturers Association, agreed: “Let’s not keep jumping into the same dry well (small businesses that pay for insurance plans) trying to solve the problem.”
“The funding raised from the 400% will not be much. It will not solve the budget problem for the ambulance service,” he added. “It cannot resolve or help the conflict between the market and ambulance providers.”
Berger proposed that EMS be considered an “essential service” and given public funding, similar to police and fire departments.
Blair Hadley, director of government relations for the Indiana Insurance Association, said the bill would affect “a small percentage of people,” especially because the state plan was removed.
When Sen. Gaskill asked why local governments aren’t “enhancing” and providing EMS, Burdick of the EMS Association said such services are not required under Indiana law and are subject to constitutional tax caps. He said he thinks this is because the government has already set a cap on local taxes.
Gaskill also worried that the bill could raise costs and reduce options for people who buy health insurance on the marketplace, such as adult children who work in family businesses.
Some blamed the federal government.
“Honestly, if Medicaid had honored its end of the agreement, we might not have had this conversation,” said Ashton Eller, vice president of health care and employment at the Indiana Chamber of Commerce. He said the reimbursement rate was too low.
Superior Ambulance Services’ Mr. Godden later countered that commercial insurance should also hold up to the end of the contract.
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