When Coloradans need emergency medical transportation, whether they receive a large bill comes down to chance — and what type of ambulance provider happens to pick them up.
Federal and state laws prevent “surprise bills” for rides in air ambulances and in ground ambulances owned by private companies, such as AMR. Most states, including Colorado, don’t have laws preventing those bills from publicly owned ground ambulances.
Last year, a small bipartisan group of lawmakers tried to change that, but pulled their bill to get more input from ambulance providers. Now, they’re working on a new plan to prevent unexpected bills in emergencies, said Rep. Karen McCormick, a Democrat from Hygiene. She anticipates having a bill ready to go when the legislature returns in January.
“We really wanted to get into a good spot with all of the (emergency medical services) providers,” she said.
Nationwide, the median ambulance bill — not the full cost, but what people were charged on top of what their insurance paid — was $450 in 2019, according to a report from the U.S. Public Interest Research Group. The report noted, though, that in some states, that billing average is more than $1,000.
House Bill 1218 would have allowed publicly owned ambulance providers to submit rates to the Colorado Division of Insurance, which insurance companies would have had to pay if their customers needed a ride. If the ambulance provider didn’t submit rates, insurers would pay 325% of the Medicare rate for the ride and whatever services the patient needed en route.
The patient wouldn’t get a “surprise bill” beyond what their insurance paid, though they’d still be responsible for any copays or other out-of-pocket costs that normally fall on them.
Lawmakers are still working on exact terms for the new bill, but the general idea this time is that local governments would figure out the cost of operating emergency medical services and use that to set rates, which insurers would have to pay, said John Seward, vice chair for government relations at the EMS Association of Colorado. About 325% of the rate Medicare pays also would cover costs for most providers, he said.
“It’s not just, ‘I’m going to make up a number to try to make money,’ ” he said. “Breaking even is the goal.”
Most parts of the state only have one ambulance provider, so insurance companies don’t see any advantage in negotiating deals to bring any of them in-network, Seward said. And even if they did want to build networks, people whose lives are in danger have to take the first ambulance that shows up, he said.
Insurance companies are in favor of protecting patients from surprise bills, but setting payments at three times Medicare’s rates is too steep, said Kevin McFatridge, executive director of the Colorado Association of Health Plans.
“These elevated rates would ultimately increase the cost of insurance premiums for consumers across the state,” he said in a statement.
Data showed a negligible financial impact on insurance companies from the rates they expect providers to charge, McCormick said, without providing specific numbers.
Publicly owned ambulance providers need rates that are high enough to cover the times when they don’t get paid, said April Valdez Villa, spokeswoman for Denver Health.
The system’s paramedics either treat someone on the scene or determine they don’t need to go to a hospital about one-third of the time, and can’t bill insurance for those responses, Valdez Villa said. Denver Health collects about 27 cents on every dollar billed for transporting people to the hospital, either because insurance underpays or the patient doesn’t have coverage, she said.
“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,” she said in a statement.
The bill will be more challenging than some because it tries to achieve three things: protecting consumers from unexpected bills, making sure small ambulance providers can stay in business, and keeping overall health care costs down, said Rep. Kyle Brown, a Louisville Democrat who is part of the group working on it.
“It’s everybody’s intention that we get consumers out of the middle of this dispute,” he said.
Communities aren’t required to offer emergency medical services, meaning that providers could close if they can’t find a way to get enough reimbursement, Seward said.
Related Articles
How will Lutheran Medical Center move 180 patients to its new $680M hospital? With a 9-hour ambulance convoy.
Denver ambulances aren’t meeting response-time goals. Can training firefighters to be paramedics help?
Despite surprise billing laws, unexpected ambulance bills remain common in Colorado
Ambulance crews can’t avoid violence but at Denver Health, they’re trying to change the culture of ignoring it
“Patients need access to EMS services, and we believe insurance companies need to be the ones to pay for it,” he said.
Setting rates would not only get patients out of the middle of disputes between ambulance providers and insurance companies, but would give emergency medical services a steadier funding base, said Isabel Cruz, policy director at the Colorado Consumer Health Initiative.
Ideally, a future law change would prevent out-of-network bills for non-emergency transportation, which often isn’t truly optional, Cruz said.
For example, the initiative’s advocates recently worked with a family that got stuck with a $6,000 bill for their child’s non-emergency ride from an emergency room to a mental health facility following a suicide attempt — a situation in which they didn’t think to challenge whether the child should be in an ambulance or ask what it would cost, she said.
“Protecting consumers from surprise bills is good policy for all parties,” she said. “Most consumers don’t have $500 or more for covering the difference.”
Sign up for our weekly newsletter to get health news sent straight to your inbox.