Stop balance billing by ambulances, state board says

The message to legislators from a state health advisory board is simple: Stop ambulance services from billing consumers for whatever is left over after insurance pays, a practice known as “balance billing.”

That can leave consumers with surprise bills of hundreds of thousands of dollars after they call 911, The Palm Beach Post has reported.

Consumers in an emergency “are not able to make an informed decision or negotiate at arm’s length about the cost of the transport,” wrote Carol Ostapchuk, executive director of the Florida Health Insurance Advisory Board, in a letter to state insurance commissioner David Altmaier.

The letter, dated Oct. 20, summarizes the board’s findings. It was released Tuesday by the Florida Office of Insurance Regulation.

Altmaier “generally supports a prohibition on balance billing because the practice can bring harm to consumers,” a spokeswoman said.

As chairman of the advisory board, the commissioner did not vote on the matter, she said.

The advisory board, whose function is to advise state officials on matters of public policy, recommended lawmakers adopt rules similar to those in a bill that passed a year ago to limit what providers can bill consumers in certain situations where they have no realistic choice of providers. Example: An out-of-network anesthesiologist at an in-network hospital.

The law limits consumer bills to the equivalent of “in-network” charges, though it excluded emergency medical transportation. A state working group has been meeting over the last year on ambulances and is expected to issue a “white paper” by December.

Most public and private ambulance services choose not to join insurer networks, because they say reimbursement is often too low. If they are effectively forced to join networks, representatives warned, it could mean higher taxes or cuts to service.

“If you don’t have balance billing, then you’re asking the taxpayers of Stuart to pick up the difference,” Stuart Fire Rescue Chief David Dyal told a state working group last month.

Ambulance officials say insufficient payment by insurers or rising deductibles in  health plans are often to blame, but insurers argue there has to be some incentive for ambulances to negotiate contracts, rather than bill consumers for whatever amount they choose.

As Post has reported since 2012, consumers like Penny Farrow of Boynton Beach feel frustrated they pay for insurance and taxes for county or city ambulance services, yet still get charged for amounts they don’t understand after they call 911.  She found found a $600 bill for a short ground ambulance trip “outrageous.”

 

 

 

 

 

 

Palm Beach ambulance official: We are ‘framed’ on balance billing

Consumers from Palm Beach County and around the state are telling Florida officials they fear calling 911 because of ambulance charges that come as a shock, but ambulance officials said at a meeting Tuesday they are being set up for blame on so-called balance billing.

“The ambulance providers are being framed as the cause of this balance billing when it’s actually the insurance provider,” said Darrel Donatto, Deputy Fire Rescue Chief for the town of Palm Beach.

Bonny and Ed Fishman say they were surprised by an ambulance charge of more than $800. (Damon Higgins / The Palm Beach Post)
Bonny and Ed Fishman say they were surprised by an ambulance charge of more than $800. (Damon Higgins / The Palm Beach Post)

Consumers may get hit with bills they are not expecting because their insurers are not covering the full amounts charged, said Donatto, who is active with state and local fire chief associations.  Any potential moves by state legislators to limit what ambulance services can bill consumers will likely shift costs to taxpayers, he said.

“The question is, should taxpayers be subsidizing the insurers with record profits?” Donatto said.

Insurance industry officials responded they are among the nation’s most regulated industries, effectively limiting profits they can keep.

“We don’t want our consumers to be receiving balance bills,” said Wences Troncoso, vice president and general counsel for the Florida Association of Health Plans.

“I think we’re both trying to achieve the same thing at the end of the day and that’s protect the Florida consumer and achieve a fair outcome,” Troncoso said.

He  asked why most ambulance services choose not to join insurer networks and come up with a mutually-agreed contracted rate.

But Donatto said in his experience, there has been “no negotiation, no willingness” by insurers to pay sufficient reimbursement, making it “fiscally irresponsible” for ambulance providers to join.

With insurers and ambulance providers often locked in a stalemate, consumers feel caught in the middle, paying amounts they were not expecting.

A state working group led by Florida Insurance Consumer Advocate Sha’Ron James is exploring possible solutions to the deadlock for legislators to consider. A meeting Tuesday in Tallahassee focused on ground ambulance charges.

Complaints to state agencies show consumers are often upset that they pay taxes for ambulance services as well as insurance premiums, only to get billed after a ride for amounts that can range from several hundred dollars to more than $1,000.

Balance bills for air ambulance rides can be far higher, $25,000 or $35,000 or more. A later meeting of the working group, proposed for June 13, will address those. Any recommendations concerning possible actions by state legislators are expected to affect the 2018 session, not this spring’s gathering.

The Palm Beach Post reported Sunday on bills such as the one for more than $800 that caught Edward and Bonny Fishman of Boynton Beach by surprise.

Boca Raton Fire Rescue Services threatened to turn the Fishmans over to a collection agency if they did not pay, the couple said.

“I was shocked,” Edward Fishman, 64, said. “What is this? We pay taxes for fire and rescue. Why is there a charge? How do they determine how much they charge?”

Consumers say such charges can force them to consider the financial consequences of calling 911 rather than just focusing on getting medical help.

Bonny Fishman, 62, said, “If God forbid we were in an emergency in the future, I would think twice about calling an ambulance.”