THE BATTLE to control health costs has many skirmish lines. One that is less visible but still has a substantial impact on medical bills is the effort by insurers to hold down the fees charged by ambulance companies that are not in the insurer’s network. The companies often hit the insurers with bills that are three to five times as high as they can charge under Medicare. Insurers have tried to force the companies to join their networks and accept more reasonable fees by making payments directly to the patients and placing the companies in the awkward position of getting the reimbursement from them.
This fall, Governor Patrick tried to hammer out a compromise: Insurers would have to reimburse the companies directly but at the insurer’s customary charge. The insurers are concerned that the ambulance companies will try to get sympathetic legislators to amend Patrick’s language to make it the ambulance company’s customary charge.
Such fees can be exorbitant. A Leominster company charged Blue Cross Blue Shield of Massachusetts $6,750 this year for a 103-mile trip that Medicare would have reimbursed at $1,196. According to Blue Cross, its members would save $60 million annually if in-network ambulances provided all trips at its customary rates, which are about 100 to 150 percent of Medicare’s. In an emergency, of course, patients cannot demand an in-network ambulance. But use of out-of-network ambulances should not place an undue financial burden on a health care system that is already barely affordable. The Legislature should stick with the governor’s language.