Wheel money: Law now requires coverage if patients decline hospital transport
Under a law adopted this year, health insurers are now required to reimburse ambulance companies for emergency aid if a patient refuses to be transported to a hospital.
Pennsylvania Act 103 amends a 97-year-old law that required insurance companies to reimburse emergency medical services, or EMS, agencies for services provided only if the patient was transported to a hospital. Act 103 was approved by the state House and Senate earlier this year and signed by Gov. Tom Wolf in October.
Prior to the new act, emergency medical services could receive zero reimbursement from a patient’s health insurance if the patient told emergency medical technicians that he or she didn’t want to be transported to a hospital for further treatment. Matthew Baily, executive director of Susquehanna Township EMS, said the Susquehanna Township-based nonprofit sees a substantial number of patients refuse transport.
“Our job is to provide pre-hospital care and get them to the hospital safely,” Bailey said. “There were no real protections if we went to a scene, treated a patient and they didn’t want further treatment.”
Bailey said that if a patient were to refuse transportation to a nearby hospital, the approximately $450 bill for treatment in the ambulance would be sent to the patient. But patients would not always pay.
“We had some people that would pay it and some that wouldn’t,” he said.
State Rep. Steven Barrar, a Republican representing portions of Chester and Delaware counties, introduced the legislation in January 2017. In a memo asking fellow lawmakers to sponsor the bill, he said that Pennsylvania EMS providers were facing a unique problem.
“Too many times EMS providers must wait to respond to a 911 call only to show up at the incident and provide care and treatment, but not transport for various reasons,” Barrar wrote. “In either case, the EMS provider responded to the call and expended time and resources on responding to the call.”
Susquehanna Township EMS continues to see costs increase for medicines, including Narcan used for narcotic overdoses. Bailey said he has not seen a drastic increase in patients who refuse service. While it is expected that an at-risk patient, like an individual receiving Narcan for a narcotics overdose, would fight to be transported to a hospital, Bailey said that Susquehanna Township EMS does what it can to get them to continue to the hospital.
“The paramedics are usually really good at emphasizing the gravity of the situation,” he said.
Insurers could also benefit from the bill, according to Bailey, who said that patients will often ask to be transported to a hospital so that their insurance will step in to pay their bills. Act 103 ensures that insurers will foot the bill in cases where a hospital may not be necessary, ultimately imiting costs for insurers.
“If we can treat this in the field there is no reason to bring them into the hospital system,” Bailey said. “We are cheaper than the hospital.”
Highmark Health spokesman Leilyn Perri, said the insurer is neutral on the law.
State Rep. Keith Gillespie, a York County Republican who is a supporter of the bill and a former paramedic, agreed that mandating reimbursements is a step in the right direction. Gillespie said that EMS agencies have continued to focus on bringing medical care to patients on the scene, saving patients both transportation fees and emergency bills.
“If it can be treated at home, then let it stay there,” Gillespie said. “It gets the ambulance back in service for potentially life-threatening calls.”
Act 103 only applies to private-sector insurers. Both Medicare and Medicaid reimburse only if a patient is transported to a hospital. However, effective in January, Medicaid reimbursements for EMS transportation will see a 6 percent increase as a part of the state’s 2019 budget.
Both Bailey and Gillespie agreed that the next step to keeping local EMS agencies in business will be to require Medicare and Medicaid reimbursements for patients that decline transportation.
“Unless people want a tremendous tax hike in their communities, getting the reimbursement will allow them to not go out of business,” Gillespie said.
Editor's note: This story has been updated to provide the correct spelling for Matthew Baily of Susquehanna Township EMS.