EMS, Patients, and Payments, Oh My! Support Senate Bill 1342 to Help EMS Work Better for You (Click for More Information)

Pennsylvania’s Emergency Medical Service providers are in a crunch right now. They are required to respond to all emergencies, every day of every week of every year, and yet they are missing crucial funds to maintain their essential operations. Why? Because they only receive a small portion of their payments from health insurance companies, and that is because much of the time the check to pay for the emergency transport is not sent directly to the EMS provider—instead, insurance sends it directly to the patient.

Some insurance companies have contracts with EMS providers promising to send their checks for payment to the EMS providers directly, but across Allegheny County there is not a single EMS provider under contract with Highmark, for example. So, when an ambulance is needed and the bill is turned in to Highmark, they always issue a check to the patient who needed the ambulance and not to the EMS provider who performed the service. According to Highmark, as an insurer they don’t pay out-of-network providers directly, and that includes EMS agencies. But EMS agencies frequently opt to remain out-of-network because it allows them to set their own rates, as being in-network can mean that they are paid less than what it costs to actually perform the emergency transport.

But there are problems with sending a check to the patient instead of to the EMS agency that needs it. The patient may have no idea what this money is for, if their insurance provider has already paid EMS for the service, or even that the EMS provider is out-of-network with their insurance. They presume the check is for them, as it’s delivered to their address, with their name on it, from their insurance company. They cash the check, carry on with their day…and then a few weeks or months later, a notice shows up from their EMS provider stating that the bill for their ambulance trip wasn’t paid. For a family living paycheck-to-paycheck, a retired individual on a fixed income, and anyone who gets blindsided by this kind of bill, this can be destabilizing to discover and feel like a betrayal. You could reasonably think that an EMS provider would receive payment directly from your insurance company—after all, you normally only receive a bill when something isn’t covered or receive a check when you have an overpayment being refunded to you. This makes the process confusing, can unintentionally land people in surprise medical debt, and means that EMS providers spend unnecessary time and money chasing down payments that they need to keep their doors open and keep serving patients in the Commonwealth.

But there is a chance to make a change: a bill known as SB 1342, the “Fair and Direct Reimbursement Rate for 911 EMS Providers” bill, is being proposed in the Pennsylvania State Senate by State Senator Devlin Robinson and has garnered bipartisan support in the State Senate. The purpose of this bill is to ensure that EMS providers are paid directly by insurance without using the patient as a go-between for the payment, regardless of whether the EMS provider is in-network or not. This eliminates an unnecessary step in the process of paying EMS for their services, meaning they’ll have more money to fund their operations, fewer outstanding bills to follow up on, and more time to spend maintaining and expanding their services. Not only that, as a patient this eliminates a potential headache for you: you won’t have to worry about making a mistake with a significant amount of money and getting a nasty surprise later on, and your insurance should ensure that the provider gets paid, since that’s part of what you pay them for!

So, what can you do right now? First, be aware that if you have called 911 and been transported in an ambulance, you should expect to receive a bill from the EMS provider followed by a check from your insurance. That check is not a refund, nor is it money you should keep; it is meant to pay your bill with your EMS provider. For Collier Township residents, our EMS provider is Collier EMS, and if you receive a mailed check, you should call them and let them know that you have the payment and would like to send it in to them. Second, if you have a question about the bill, the check, the service provided to you, or any outstanding balances you may have, please call your EMS provider or your health insurance to confirm the answer because health insurance is expensive enough that you do not want to make a mistake. EMS contact information may be available on your municipality’s website, or if you have not yet received a bill with their contact information on it you can Google your EMS provider to find their number or website. Your health insurance’s billing department or customer support number should be available on the back of your insurance card, on their website, or in their app.

Finally, please call or email your state representatives and senators and encourage support for SB 1342 and its companion bill in the Pennsylvania House of Representatives, House Bill (HB) 1152. By expressing your support, you can encourage your elected representatives to sponsor a bill that drives medical billing progress and help this become law in the Commonwealth of Pennsylvania. Being driven to a hospital in an ambulance now shouldn’t drive you crazy later—tell your representatives about SB 1342 and we can get one step closer to sensible billing.