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August 6, 2012

Ambulance billing shift in governor's hands

BOSTON — As Gov. Deval Patrick weighs a bill that would require insurers to pay private ambulance companies directly for the cost of a transport, supporters and opponents of the legislation are both trying to use the governor’s focus on health care cost containment as leverage.

While insurers and business groups are warning that the bill on Patrick’s desk could add $80 million to ambulatory costs, municipalities and a majority of legislators say the changes in the bill would impose a rate cap for the first time on ambulance services and provide stability for providers.

The issue of payment for ambulance services cropped up in 2011, when Blue Cross Blue Shield of Massachusetts and other insurers began reimbursing subscribers directly for the cost of a ride, shifting the responsibility for paying the ambulance company to the patient.

Insurers hoped this practice would encourage private ambulance providers to join their networks and negotiate contracts for lower rates, but service providers say patients often fail to pay in a timely manner, or at all.

And while the shift has exempted municipally-run emergency squads, critics of the practice have noted that Blue Cross and other insurers have refused to include that exemption in any statute, sparking criticism and concern from emergency departments that bank on keeping current with ambulance squads revenues. That includes in Gloucester, where the city’s Fire Department staffs and runs ambulance squads that bring in more than $1 million per year. “They’re not driving down the cost of health care,” Marshfield Fire Chief and state association president Kevin Robinson said at the time, joining then-Gloucester interim fire Chief Phil Dench and emergency services coordinator Sander Schultz in a visit to the Times. “They’re shifting it, onto us and onto our communities and our taxpayers.”

During the last legislative session, Patrick vetoed a bill that would have banned direct payments to patients, returning the bill to the Legislature with an amendment that would have capped payments at 300 percent of Medicaid, or the usual rate paid by insurers, instead of ambulance providers.

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