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Patient Care

Penn. EMS Fret Over Bill Aiming to Reduce Surprise Medical Bills

The Sentinel, Carlisle, Pa.

A proposed state law designed to protect emergency room patients from crippling bills has become controversial, with opponents warning it will cause “people to die.”

House Bill 1862 aims to help emergency patients who have insurance but nevertheless receive huge bills because they were treated by out-of-network health care providers.

“We’ve heard of a number of such cases around the state, including a patient who was billed over $2,000 for blood tests that were taken at an in-network hospital by an in-network doctor but sent for analysis at an out-of-network lab,” said state Rep. Tina Pickett, R-Towanda, the bill’s prime sponsor, in a news release. “In another case, a patient had surgery at an in-network hospital performed by an in-network surgeon but was billed $1,300 for services provided by an out-of-network anesthesiologist. You can imagine their shock when those bills arrived in the mail.”

Pickett’s proposal would limit out-of-network providers to charging insurance companies the median in-network rate and charging patients their in-network cost-sharing amount. It appeared on pace to sail smoothly through the Legislature when it unanimously passed the House Insurance Committee on Oct. 29.

However, the bill has received opposition from a group that wasn’t even its primary target: emergency service providers. The Ambulance Association of Pennsylvania, for example, warned that in its current form, the bill will “result in the rapid demise of the emergency medical services system in Pennsylvania.”

“People will die because of it,” the association said in a news release.

The trouble is that average in-network reimbursement rates are simply not good enough, Cumberland Goodwill EMS Assistant Chief Nathan Harig said.

“That rate is substantially lower than what they currently pay us, which is the out-of-network rate,” Harig said. “We would have to accept less money.”

In fact, most EMS providers don’t have in-network agreements with any private insurance companies because of the “poor” in-network reimbursement rates those companies offer, he said.

EMS providers are already required to accept Medicare and Medicaid payments, which are typically inadequate to cover the costs of emergency services, according to the Ambulance Association of Pennsylvania. As a result, EMS providers have shifted costs to commercial insurance companies and their patients.

Cumberland Goodwill EMS offers payment plans and write-offs for financial hardship, Harig said. People who purchase an ambulance membership also will not be charged for the balance of their bill.

“It’s our goal to help people,” he said. “We just have to make sure we have the resources to do so.”

The debate over billing comes during an already fragile time for emergency services in Pennsylvania, which has seen sharp reductions in certified EMS personnel and licensed EMS agencies throughout the past decade.

Support for the bill

House Bill 1862, in its current form, is also opposed by the Pennsylvania College of Emergency Physicians. It is supported, however, by the Pennsylvania Health Access Network, SEIU Healthcare Pennsylvania and the Pennsylvania Council of Churches as a way to address the problem of sudden medical costs.

The Pennsylvania Health Access Network cited a 2018 Kaiser Family Foundation poll finding that two-thirds of Americans are worried about unexpected medical bills.

“(House Bill 1862), which represents a strong bipartisan solution that would prevent surprise medical bills, is designed to protect patients while reining in out-of-pocket costs and maintaining patients’ access to doctors,” PHAN says on its website. “It establishes a fair and equitable process for resolving the issues behind surprise medical bills, ensuring that providers are paid fairly.”

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