PITTSBURGH -- State Rep. Bernie O'Neill, a Republican from Bucks County, didn't know what to do with the check that arrived from his insurance company.
His sister, a special-needs adult who lives with him, broke her ankle from a fall in a nearby park, resulting in an ambulance ride to the hospital. Now, O'Neill was holding a reimbursement check made out to him that paid for the ambulance ride.
Most of the 49 ambulance services in Allegheny County are failing financially in part because patients don't know to pay them, or choose not to, O'Neill said.
So he proposed a bill, approved by the House Veterans Affairs and Emergency Preparedness Committee last week, that would allow ambulance services to receive reimbursements directly from insurance companies.
The bill now moves to the House for consideration.
"I don't see a huge financial burden being placed on the insurance companies," O'Neill said. "They're just changing the typing on a check and an envelope."
City Controller Michael Lamb said Pittsburgh's ambulance service is not struggling financially because it contracts directly with insurance companies, an option smaller companies say does not make economic sense for them. The city's EMS service costs it about $12 million a year to operate, $8 million of which it recoups from insurance companies. Taxpayers foot the balance.
The average cost of an ambulance ride in Pennsylvania is $601, said Allegheny County EMS Manager Knox Walk, of which insurance companies usually reimburse $100 to $120. Patients pay the rest, or should, but don't because the process confuses them, Walk said. Some send the ambulance company the reimbursement check, the "vast majority of revenue" for most companies, he said.
"Making direct reimbursement is important for the continuation of EMS, not just in Pittsburgh but the whole state," Walk said.
Some departments are able to recover only about 35 percent of the cost to put the ambulance out the door, O'Neill said.
His bill would allow patients to sign paperwork that would instruct their insurance companies to send reimbursement for the ride directly to the ambulance service.
Michael Weinstein, a spokesman for Highmark Blue Cross Blue Shield, said the insurance provider opposes the bill because it does not make direct payments to providers outside its network. Highmark encourages ambulance providers to sign a contract with the company, he said.
Don DeReamus, legislative chair for the Ambulance Association of Pennsylvania, said a bill like O'Neill's has never made it to a vote in the House or Senate.
"We've been fighting this battle for a good six to eight years in the Legislature. ... We're fighting money," he said.
Rep. Anthony Melio, chairman of the House Veterans Affairs and Emergency Preparedness Committee, said the bill only addresses volunteer ambulance services, or those primarily staffed by nonpaid EMTs. But O'Neill said he intends to amend the language to include all ambulance services.
While volunteers did 80 percent of EMS work 20 years ago, they account for only about 10 percent now. Few companies today are composed solely of volunteers, Walk said.
"It is a critical issue across the state because we have been losing tons and tons of money," DeReamus said.