Indiana lawmakers are considering legislation that would peg all of the state’s ambulance and transportation costs to in-network rates.
The Senate’s Insurance and Financial Institutions Committee will decide by the end of February whether to pass the bill with its current language.
House Bill 1372 attempts to eliminate instances of patients getting surprise bills after receiving emergency medical services that weren’t covered by insurance.
Many EMS providers lobbied against the bill, saying setting costs at in-network rates will dramatically cut the industry’s already low revenue.
Matt Zavadsky is the president of the National Association of Emergency Medical Technicians. He says EMS providers don’t reap the same benefits of in-network rates as regular healthcare providers. Primary care physicians who go with in network rates usually get more patients, which usually compensates for reduced fees.
“People aren’t going to call 9-1-1 more just because we’re now in-network with any of their insurance payers,” he says." The concept of accepting an additional rate without having an additional volume to help cover the lost revenue per call doesn't work in the emergency medical services industry setting."
In-network rates would lock in the universal rate for transportation costs.
Zavadsky says this means Indiana EMS services could receive less compensation than what it costs to operate.
He also says tax payers will either have to make up for the revenue loss or accept a decrease in services in their community if the bill’s language remains unchanged.
Before any laws are passed changing reimbursement rates for EMS providers, Zavadsky says lawmakers should examine how much healthcare costs more carefully.
He suggests using the FAIR datatbase which looks at costs of all healthcare by region, rather than setting a statewide average.
"Instead of going right to, getting a statewide, in-network rate for ambulance services, maybe the first step is finding out what it really costs to provide ambulance services in the communities across the state of Indiana."
He says under HB 1372's current language, insurance companies would be the primary beneficiary.
"If the insurance companies have to pay less, they benefit financially," Zavadsky says. "The patient is going to get a higher bill from the ambulance provider. The ambulance providers are going to have a reduced reimbursement, which means they're going to suffer."
The Senate committee is considering two amendments to the bill, one of which would remove the in-network rates for providers that are owned by or have a contract with a municipality.
The other would allow ambulance providers and insurance companies negotiate prices of transportation costs.
