Massachusetts Governor Rejects Ambulance Payment Legislation

Health insurance companies are praising Gov. Deval Patrick’s decision to kick back to the Legislature a bill that would ban insurers from sending payments for out-of-network ambulance services to patients, who are then supposed to pay the service providers.

The governor Tuesday sent back the legislation with an amendment giving insurance companies the right to set cost rates for out-of-network ambulance providers. The bill approved by the House and Senate would have upheld the ambulance companies’ right to set the rates, albeit with a cap of no more than three times what Medicare pays. The governor rejected a similar bill in 2010.

“The governor has been very focused on addressing the cost of (health) care,” said Jay McQuaide, spokesman for Blue Cross Blue Shield of Massachusetts. “This is legislation, had it passed, that would have added tens of millions of dollars on premiums that our members pay. This really is an issue of affordability.”

In recent years, health insurance companies, in an effort to get private, out-of-network ambulance providers to lower their rates, started paying patients directly. The patients are then expected to pay the private ambulance companies.

Critics of the practice, including Marshfield Fire Chief Kevin Robinson, said it prevents ambulance companies from getting the money they need to offer quality care on emergency calls. Robinson said Patrick’s amendment undercuts the purpose of the bill.

“This is bad for every emergency ambulance provider because it allows the insurers, who are not in the ambulance business, to determine what would be an appropriate rate,” Robinson said. “We know their proposed rate is well below the cost of delivering the service.”

McQuaide said the practice of paying patients applies only to privately owned ambulance services. Municipally owned ambulance providers are exempt, he said.

State Rep. James Cantwell, D-Marshfield, sponsor of the ambulance bill, said the Legislature will reconsider the bill in informal session or revisit it next year.

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