CNY ambulance providers struggle due to inefficient pay model
Syracuse-area assemblymembers and colleagues across the state are calling on Governor Kathy Hochul to sign legislation that ensures ambulance providers get paid for their services. Officials say smaller, rural providers are at risk of going out of business, leaving residents vulnerable if they face a medical emergency.
The trouble begins when a service is performed “out of network.” Instead of reimbursing the provider, health insurance companies send the checks to patients, which might get missed if they’re buried in other paperwork. The patient is eventually sent a bill, and is supposed to use the money to reimburse the provider. But Assemblymember Bill Magnarelli says ambulance services are owed millions of dollars from patients who end up keeping the checks. He’s sponsored the ”Direct Pay” bill since 2015.
“Many ambulance service providers are struggling, faced with sharply rising costs associated with personnel, healthcare benefits and collection fees associated with the out of network health insurance carriers.”
Magnarelli says ambulance providers are mandated by law to respond, evaluate, treat, and transport patients, regardless of insurance.
Vice President of Operations with AMR Northeast Mike Addario says the vast majority of ambulance services are provided at no cost to taxpayers.
“We exist solely on the fee for service that we're able to collect for the services that we provide," Addario said. "We respond to several million calls each year across the state. Reimbursement has certainly hindered our ability to continue operating as ambulance services. It's put tremendous amount of pressure on us, especially in this post COVID environment.”
To add to the stress, Addario says there are 13 percent fewer EMS responders than there were ten years ago, and they’re handling far more emergency calls. He says the direct pay bill will help sustain their operations, while also helping patients.
“It will take the patient out of the middle, which often happens now," Addario said. "Patients get confused when they receive payments checks. They're not sure what to do. So this will alleviate the burden for them.”
Lawmakers are confident Governor Hochul will sign the bill because of its health and safety implications, though she’s been pressured not to by the powerful health insurance lobby.