What happened: A recent study from Ohio State University found that a New York law intended to protect patients from out-of-network ambulance bills, led to an unexpected 13% increase in ambulance costs for residents. Under this legislation, ambulance services in New York are required to bill at 鈥渦sual, customary and reasonable鈥� rates, shifting the financial burden to insurance companies. However, EMS providers raised their rates, leading insurers to raise premiums to offset these new costs, creating a cycle of rising expenses for patients and insurers alike.
| More: Researchers: Law to prevent surprise ambulance bills may be driving up costs
Highlights
Watch as Ed Bauter, MBA, MHL, NRP, FP-C, CCP-C; and Daniel Schwester, MICP, highlight the significance of this development, including:
- Balance billing burden. This process charges patients for costs that insurance doesn鈥檛 cover, which the law sought to prevent; however, higher rates are being passed on to patients through insurance premiums.
- Insurance premium feedback loop. As ambulance services increase their rates, insurance companies have responded by raising premiums for patients based on their anticipated ambulance use, which perpetuates a costly cycle.
- Long-term EMS impact. As healthcare costs rise, patients may avoid preventive care due to financial strain, increasing the strain on EMS systems as more people turn to emergency services as a last resort.
The path forward
The unintended consequences of New York鈥檚 balance billing law highlight the challenges in designing regulations that protect patients without exacerbating costs. EMS leaders argue that clearer cost controls and standardized reimbursement rates could prevent this inflationary cycle. Moving forward, a balanced approach will be essential to sustaining EMS operations and ensuring patients can access necessary care without incurring unmanageable debt.
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