Insurers’ ambulance bill practice protested

By Kyle Cheney
State House News Service / April 26, 2011

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Cities and towns could be forced to sue their own residents, eliminate life support services, and pay higher health care bills unless the Legislature reins in an attempt by health insurers to slash ambulance costs, said lawmakers, fire chiefs, and municipal officials yesterday.

“We’re not asking for a handout, we never are. We’re asking for a fair deal,’’ said Mayor Robert Dolan of Melrose, speaking at a State House press conference. “All we ask is not to be victimized by needless cost-shifting by Blue Cross Blue Shield.’’

At issue is a practice recently implemented by Blue Cross Blue Shield of Massachusetts intended to cajole ambulance providers to join the company’s contracted network: Rather than pay for ambulance services provided by out-of-network companies, Blue Cross will cut a check to patients for the cost of their ambulance ride. That would leave it up to the ambulance companies to seek out their patients and collect the check.

Blue Cross argues that the indirect payments will entice ambulance companies to sign contracts, lowering rates for ambulance services and controlling health care costs. But officials at yesterday’s press conference rejected that argument, contending instead that the policy would provide a “profit motive’’ to people who frequently, and fraudulently, seek ambulance care and force emergency services costs on cities and towns grappling with high health care costs and reduced state assistance.

“If we make this radical change of paying patients directly, it’s going to amount to be a local aid reduction,’’ said state Representative James Cantwell, Democrat of Marshfield.

In addition, Cantwell argued that Blue Cross’s strategy would force cities and towns to decide whether to sue their own residents to collect unpaid ambulance bills, a fact that would not only present an uncomfortable challenge but also cause cities and towns to pay for lawyers.

Instead, municipal officials and fire chiefs from around Massachusetts urged support for a plan filed by Cantwell that would force insurers to pay ambulance companies directly for the cost of emergency services. The proposal would also limit the cost of an ambulance ride to the ambulance providers’ customary rate or a rate established by the governing body of a municipality, whichever is lower. In addition, insurers would still be able to pay indirectly for “nonemergency services.’’

Kevin Robinson, Marshfield’s fire chief and president of the Massachusetts Fire Chiefs Association, estimated that 48 percent of the services ambulance companies provide are for nonemergency purposes such as transfers from a hospital to a nursing home.

Cantwell’s proposal was filed as an amendment to the House budget, which is up for debate this week. Kevin Paico, town manager of Foxborough, said efforts by lawmakers to cut the cost of health care for cities and towns would be entirely negated if all insurers pay patients directly, rather than ambulance companies, for the cost of ambulance services. He also said it was likely that some cities and towns would “terminate advanced life support services’’ often provided by ambulance companies because they would prove too costly.

Blue Cross and a string of business groups sent a letter to House members Sunday urging them to reject Cantwell’s proposal, saying it would permit ambulance companies to charge exorbitant rates for the cost of their services. In addition, amendment opponents say Blue Cross will continue to pay municipal ambulance providers directly, and they note that the Division of Insurance recently agreed that those providers should be exempt from indirect payments.

The proposal, the groups say, would incentivize ambulance providers to abandon insurers’ networks, establishing “a dangerous precedent that other providers would seek to follow.’’