Allison Adams ran into bad luck twice when visiting Denver last August: first, when she broke her leg stepping off a curb, and then when a publicly owned ambulance responded to her call.
If a private company had owned the ambulance, Adams would have had protection from so-called surprise bills under Colorado law. But the law includes an exception for ambulances owned by cities, counties and special districts, which can bill patients for whatever their insurance didn’t pay, a practice known as balance-billing.
A bill in the state legislature would give patients who end up in publicly owned ambulances the same protection as others who need emergency medical care.
Protections in Colorado already exceed those in most states. The federal No Surprises Act exempts all ground ambulances, though it prevents balance-billing by air ambulances.
Adams, who lives in South Carolina, said her insurance company, Highmark Health, doesn’t contract with Denver Health paramedics, and paid only $392 for her ride from the Capitol Hill neighborhood to HCA HealthOne Presbyterian St. Luke’s hospital.
That left her with an $1,104 bill, and no options other than setting up a payment plan.
“They could have charged me a million dollars, and I would have been stuck with it,” she said.
Highmark didn’t respond to a request to comment on Adams’ situation. Denver Health said it has no choice but to balance-bill, because it doesn’t get paid for the one-third of ambulance runs where no one goes to a hospital, and insurance companies typically don’t cover the full cost of transporting their customers.
“What we would need to be sustainable without balance-billing is for commercial plans to pay a consistent rate that covers cost and includes the unreimbursed cost of responses with no transports,” Denver Health said in a statement.
Colorado’s House Bill 1088 would prohibit ambulances from billing patients beyond what their insurance covers. Insurers would then have to pay “reasonable” rates set by the city, county or special district that owns the ambulance service.
Patients would still have to pay their normal share of the cost of their care, which could be either a flat co-pay or a percentage of the bill.
The Emergency Medical Services Association of Colorado worked with the bill’s sponsors and supports the current version. The Colorado Association of Health Plans, a trade group representing insurance companies, said it would like to see amendments to the bill.
“The Colorado Association of Health Plans is concerned about providers setting their own rates and then seeking legislative mandates to require insurers to pay those rates. This approach could drive up health care costs for consumers and limit efforts to keep care affordable,” spokesman Kevin McFatridge said.
Under the bill, a municipality would have to justify why its ambulances needed higher rates if they exceeded 325% of what Medicare would pay. Emergency medical service providers that didn’t submit rates to the state Division of Insurance couldn’t receive more than 325% of the Medicare rate.
That rate has worked well for most private ambulance providers under the current law, said Sean Caffrey, CEO of Crested Butte Fire and Emergency Medical Services. Insurers typically aren’t interested in contracting with small ambulance services, and requiring them to pay that rate may be the only way that providers can stay afloat without balance-billing patients, he said.
“The primary goal (of the bill) is to get the patients out of the middle,” he said.
Ambulance providers don’t want to send patients a large surprise bill, both because the patient likely won’t be able to pay and because, at least in small towns, they’ll have to run into unhappy neighbors at the grocery store, Caffrey said. But the only other option, if insurers won’t cover the cost of services to their customers, is to pass the cost on to taxpayers, he said.
Adams said she hopes Colorado’s law changes, so people who have emergencies don’t have to weigh their need for help against the possibility of a large bill if the ambulance that responds isn’t in their insurance network.
“You don’t have a choice in what company comes,” she said.
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