By: Kaitlyn Sprague
The Commonwealth of Massachusetts Legislature’s Joint Committee on Financial Services held a public hearing on a number of matters related to insurance reimbursements for ambulance services in early April. Insurance providers that are not under contract with certain ambulance service providers have been unable to come to an agreement on a rate for services provided to their customers. To evade this problem, some insurance companies have started paying their customers directly for ambulance services. In turn, ambulance service providers are in the unfortunate position of having to recoup funds through the consumer, potentially having to sue for the money: a no-win situation. Legislating a solution puts the price setting problem in the hands of the legislature. Two bills filed by Representative Cantwell heard at the Financial Services hearing in April seek to give that price setting power to the service providers. This power is granted to service providers whether they are a municipal ambulance service or a private company, excluding health insurers from the discussion. H.862, An Act relative to the use and payment of ambulance services, directs insurers to pay service providers directly and creates a cause of action against any insurer who fails to pay in accordance with this section. This bill sets the rate of payment for ambulance services at the lesser of the provider’s usual rate or three times the current published rate for ambulance services under Medicare. The language does not create an entitlement to ambulance service coverage if the insured’s policy does not cover it. A different bill, H.863, An Act relative to payment for use of ambulance services, has a similar framework, but sets the payment for the ambulance service at the rate established by the municipality from which the patient was transported. H.863 is cosponsored by nearly half the House. Both H.862 and H.863 remain in the Joint Committee on Financial Services awaiting disposition at the time of this writing.