Federal panel punts on high cost of ground ambulance trips

December 1, 2023

The No Surprises Act prohibited balance billing for emergency services and services where patients have no choice about providers, including hospital-based physicians (emergency department, radiology, anesthesia, and pathology) and air ambulances. However, ground ambulances were allowed to continue to balance bill patients for out-of-plan services, as Congressional negotiators couldn’t agree about how to control costs for this service.

Almost two thirds (62%) of ground ambulance rides are provided by local fire departments, which argued that substantial fee cuts could force them to cut services. Over half of all ambulance rides are out-of-plan, and KFF (formerly Kaiser Family Foundation) found that 51% of emergency ground ambulance rides and 39% of non-emergency ground ambulance rides were associated with an out of network charge. These high cost ambulance rides lead to patient bills that can be thousands of dollars beyond what is covered by insurance.

The No Surprises Act required a committee to make recommendations on how to address out-of-plan ground ambulance charges, and preliminary recommendations were discussed at the Committee’s November meeting. These include:

• Designating ground ambulance services as an essential health benefit

• Recommending that rates be set by states and local governments after negotiation with medical carriers

• Limiting patient copayments to the lesser of $100 per ambulance ride or 10% of what insurance pays for out-of-network ambulances.

• Streamlined bills that would be easy for patients to understand

• Prompt payment or denial of ground ambulance claims
  
  

The No Surprises Act relies on independent dispute resolution for air ambulance and other regulated bills, but this process has proven cumbersome and there are huge backlogs, so the advisory committee did not suggest using this process for ground ambulance bills.

Final recommendations are expected in Q1 2024.

Implications for employers:

• These recommended rules will help eliminate the uncertainty and financial insecurity of patients who require ambulance transportation. However, there is no mechanism to require reasonable bills.

• Some nonemergency, scheduled transportation between facilities could be appropriately supported by wheelchair vans, rather than an ambulance. Employers can ask their carrier what their policy is for these services and if wheelchair vans can be an option.

• Decreasing balance billing could unfortunately mean that some ambulance companies would increase their fees even further.

• We can only keep health insurance affordable by controlling the overall price paid - not by limiting cost sharing alone.

• Many states have put in place regulations to cap prices for ground ambulance rides; such rules can help control health care expenditures and keep insurance premiums more affordable but unfortunately are generally only applicable to state regulated fully insured plans.

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