CARLISLE, Pa. (WHTM) – People using EMS companies as ATMs: it’s a big problem in Pennsylvania. For the first time, legislation to address the issue is moving through the state Senate.
At Cumberland Goodwill EMS, they roll out every time they get a call, but not every patient pays their ambulance bill.
“September alone we just saw another $15,000 lost as a result of these patients getting payments directly from their insurance that haven’t been coming back to us,” Nathan Harig with Cumberland Goodwill EMS said. “Patients pocket it. There’s no legal requirement for them to give it to the EMS agency and it’s just a major source of waste fraud and abuse.”
For years, legislation has been sitting in the Senate Banking and Insurance Committee. It’s aimed at reducing fraud by having health insurance companies pay ambulance providers directly.
For the first time, House Bill 347 and House Bill 837 will go to the full Senate for a vote, but they’re going with amendments.
“An insurance has their established rates that they pay in-network. Even though an ambulance company might not be participating in in-network provider, they’re still going to get paid whatever that insurance company does,” Harig said.
Insurance companies like Capital Blue are on board.
“We wouldn’t want someone else to be able to come in and charge our members just whatever rate is out there,” Aji Abraham of Capital Blue said. “As I understand it, the legislation now has them accepting whatever the rate is we contract with our other provider of us. So, that addresses the first concern.”
Harig said the bills are a compromise, but no cure.
“It definitely is a step in the right direction,” he said. “It’s not necessarily perfect. We still have concerns that we might be underpaid from an insurance, but at least there’s progress being made towards resolving the problem of rampant ambulance fraud.”
The legislation has to pass the Senate, the House of Representative, and get Governor Tom Wolf’s signature before it can become law.