(Webinar synopsis) Ambulance emergency: Time to remedy ambulance surprise billing

WASHINGTON — In 2023, the federal Ground Ambulance and Patient Billing Advisory Committee crafted recommendations regarding ambulance surprise bills, as directed by the No Surprises Act, which exempts ground ambulances.The committee’s only consumer representative, U.S. PIRG Education Fund’s Senior Director of Health Care Campaigns Patricia Kelmar, and several other experts held a briefing Wednesday to educate the public, media and decision-makers about this crucial public health and consumer issue.  A triad of Cabinet departments is expected to send those recommendations and the committee’s final report to Congress before the end of July. 

“The report will be coming out in the next few weeks,” said Asbel Montes, who chaired the federal Ground Ambulance & Patient Billing Advisory Committee. “Our advisory committee had a 100% agreement on a definition that includes insurance coverage for situations when a patient arrives at a hospital that doesn’t have the services the patient needs, and the patient needs an ambulance that brings them to another hospital for the right care. And we had a lot of discussion on what the rate should be for ambulances who provide the care.”

Kelmar’s presentation included data that showed patients who need emergency ground transportation have a 50% chance of being exposed to an ambulance surprise bill — and having to potentially pay exorbitant out-of-network costs. 

That doesn’t only affect people taken to the hospital, according to Dr. Ritu Sahni, M.D., M.P.H.,  the emergency physician who moderated the web briefing.

“Ambulance care in the pre-hospital setting — in the home – impacts patient outcomes, reducing patient morbidity and mortality, so this should not be considered as a ‘transportation’ benefit only,” Dr. Sahni said.

In the absence of a federal solution, 18 states have passed related laws to protect their residents. The briefing included a presentation on Washington state’s new ambulance surprise billing law, showing the value of state experiences in finding solutions on the federal level. 

“When Congress was considering the No Surprises Act, states that had already passed surprise billing laws were able to tell Congress, ‘Yes, we can do this,’ and we shared what we learned, “ said Jane Beyer, the senior policy advisor for Washington state’s Office of the Insurance Commissioner. “We really like the idea of Congress taking on this issue and hope they will allow states who have already passed bills with greater protections to keep them.”

The Advisory Committee took all the information available to them to come up with solutions to recommend to Congress.

“As a committee, we spent 6 months looking at data, hearing from experts and hammering out recommendations,” said Kelmar. “I hope within a week of the report’s release, there will be a bill introduced that takes our recommendations…it’s long overdue.“