Ambulance bills become subject of surprise billing sequel

• Ambulances are "the backbone of saving lives," said Patricia Kelmar, a director at Public Interest Research Group and a member of the federal ambulance billing advisory committee.
• But the country's emergency response system is dysfunctional. "Unfortunately, patients who need emergency services have really been carrying a lot of the cost of those services," she added.
• Congress decided to exclude ambulance rides from the landmark 2020 surprise medical billing legislation and instead charged an advisory committee with recommending a policy fix specific to the ambulance industry.

Driving the news: A committee of ambulance providers, patient advocates, insurance experts, and other advisers is recommending Congress adopt a tiered payment system for reimbursing out-of-network ambulance rides.

• Under the proposed policy, insurers would pay ambulance providers either an amount set in state law, if one exists, or locally set ambulance rates.
• If local rates also don't exist, insurers would pay a congressionally-determined rate that's higher than Medicare reimbursement.
• Advisers also suggested a $100 cap on patient costs for out-of-network ambulance rides. This could keep insurers from passing costs along to patients if local governments set high rates for ambulance rides, Kelmar said.
• The advisory committee's report was released publicly at the end of August, though the committee adopted the recommendations earlier this year.

The big picture: Nearly 60% of ground ambulance rides were out of network in 2022, according to FAIR Health.

• Unlike some other forms of care, patients typically don't have the luxury of shopping around for an ambulance provider. Non-emergency transportation between hospitals often ends up generating surprise out-of-network bills, too.
• Some municipalities run their own ambulance fleets, while other communities rely on companies or hospitals to operate the vehicles.
• More than 15 states have passed their own surprise ambulance billing restrictions in the absence of federal policy.

What they're saying: "It's very exciting to see that there's a chance to get the patient out of this uncomfortable spot in the middle between us and their insurer," said Shawn Baird, advisory committee member and CEO of Metro West Ambulance.

Between the lines: The federal government is already struggling to implement existing surprise billing protections. The law's process for hashing out billing disputes between insurers and providers has been tied up in litigation.

• The advisory committee narrowly voted against recommending a similar dispute resolution process for ambulance bills.
• The arbitration process in the surprise billing law has "proven in the years since to be an abject failure," committee member Adam Beck, a senior vice president at the insurance trade association AHIP, said during the meeting.
• "Setting up any [dispute resolution] system is ill-advised," he added, according to the report.

What to watch: Patients wouldn't benefit from the committee's recommendations unless Congress opts to pursue legislation — a long shot this year.

• Aside from protecting patients from surprise ambulance bills, Congress could also explore requiring Medicare and private insurers to pay higher rates to rural ambulance providers and enabling community paramedics to take on increased health care delivery responsibilities, the report suggested.