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Bill to Force Direct Pay for Ambulance Rides Advances in Mass.

BOSTON -- A tactic employed by insurance companies to cajole ambulance providers to sign long-term contracts would be blocked under a bill that won the backing of a key legislative committee Friday.

The proposal, the latest iteration of a bill that has started and stopped on Beacon Hill for nearly two years, would force insurers to pay ambulance providers directly for their services. Some insurers, attempting to pressure out-of-network ambulance companies to sign contracts locking them into set rates, have begun paying patients for the cost of rides, forcing the ambulance companies to pursue them to get paid.

The move raised hackles within ambulance companies, who argued that the tactic would cost millions of dollars and lead to fraud.

Some patients, they said, would simply pocket the insurance checks rather than use it to pay for their ambulance ride. In addition, ambulance companies argued that the varying rates they charge simply reflect differing levels of complexity for ambulance rides.

Municipal fire departments, many of which operate publicly funded ambulance providers, worried that they would be hit with higher costs at taxpayers' expense, despite promises by insurers that they wouldn't target municipal ambulance companies.

Ambulance drivers can't refuse patients based on their insurance carrier, they note.

Insurers have argued that the method is a creative way of controlling costs that has proven effective in other health-care specialties.

The latest iteration of the proposal, which on Friday cleared the Committee on Health Care Financing, a month after it cleared the Committee on Financial Services, would force insurers to pay ambulance companies "directly and promptly" for the cost of a ride.

The rate ambulance companies could charge would be "equal to the rate established by the municipality where the patient was transported from."

Ambulance companies who receive such payment "shall be deemed to have been paid in full" and would lose the right to sue for additional reimbursement.

In addition, the proposal would expire on Jan. 1, 2014, the day many provisions of a federal health-care law are set to take effect.

The proposal has won the backing of municipal fire chiefs. Marshfield Fire Chief Kevin Robinson, who has railed against insurance companies for blocking earlier versions of the proposal, called the latest legislation "yet another compromise in an effort to bring this to closure."

Robinson, immediate past president of the Fire Chiefs Association of Massachusetts, said he and his colleagues have been reaching out to Gov. Deval Patrick to win support.

Insurers reject the proposal as codifying the status quo, contending that it will permit companies to charge unaffordable and sharply varying rates.

"At a time when the community is making such significant progress on improving the affordability of health care, we can't take a step back and allow a service provider - i.e. out-of-network ambulance companies - to continue to charge our customers rates that are excessive and are on average, three to five times higher than what Medicare pays for our services," said Jay McQuaide, spokesman for Blue Cross Blue Shield of Massachusetts. "The governor has offered a very fair and reasonable compromise."

In 2010, lawmakers agreed to a proposal to force direct payments to ambulance companies but limit the rates that ambulance providers could charge to three times what Medicare charges for an ambulance ride or the ambulance company's "usual and customary" rate.

Gov. Patrick returned the proposal with an amendment that would have flipped the proposal on its head, allowing insurers to charge their "usual and customary rates." Lawmakers never acted on the governor's proposal and it died in January 2011.
 



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