By Meg Wingerter
The Denver Post
DENVER 鈥� When Coloradans need emergency medical transportation, whether they receive a large bill comes down to chance 鈥� and what type of ambulance provider happens to pick them up.
Federal and state laws for rides in air ambulances and in ground ambulances owned by private companies, such as AMR. Most states, including Colorado , don鈥檛 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鈥檙e 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.
鈥淲e really wanted to get into a good spot with all of the (emergency medical services) providers,鈥� she said.
Nationwide, the median ambulance bill 鈥� not the full cost, but what people were charged on top of what their insurance paid 鈥� was $450 in 2019, according to a . The report noted, though, that in some states, that billing average is more than $1,000.
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鈥檛 submit rates, insurers would pay 325% of the Medicare rate for the ride and whatever services the patient needed en route.
The patient wouldn鈥檛 get a 鈥渟urprise bill鈥� beyond what their insurance paid, though they鈥檇 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.
鈥淚t鈥檚 not just, 鈥業鈥檓 going to make up a number to try to make money,鈥� 鈥� he said. 鈥淏reaking even is the goal.鈥�
Most parts of the state only have one ambulance provider, so insurance companies don鈥檛 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鈥檚 rates is too steep, said Kevin McFatridge , executive director of the Colorado Association of Health Plans .
鈥淭hese elevated rates would ultimately increase the cost of insurance premiums for consumers across the state,鈥� 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鈥檛 get paid, said April Valdez Villa , spokeswoman for Denver Health .
The system鈥檚 paramedics either treat someone on the scene or determine they don鈥檛 need to go to a hospital about one-third of the time, and can鈥檛 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鈥檛 have coverage, she said.
鈥淲hat 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,鈥� 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.
鈥淚t鈥檚 everybody鈥檚 intention that we get consumers out of the middle of this dispute,鈥� he said.
Communities aren鈥檛 required to offer emergency medical services, meaning that providers could close if they can鈥檛 find a way to get enough reimbursement, Seward said.
鈥淧atients need access to EMS services, and we believe insurance companies need to be the ones to pay for it,鈥� 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鈥檛 truly optional, Cruz said.
For example, the initiative鈥檚 advocates recently worked with a family that got stuck with a $6,000 bill for their child鈥檚 non-emergency ride from an emergency room to a mental health facility following a suicide attempt 鈥� a situation in which they didn鈥檛 think to challenge whether the child should be in an ambulance or ask what it would cost, she said.
鈥淧rotecting consumers from surprise bills is good policy for all parties,鈥� she said. 鈥淢ost consumers don鈥檛 have $500 or more for covering the difference.鈥�
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