ROCHESTER, N.Y. (WROC) — While the Governor has yet to announce a decision on whether she’ll sign what’s called the ‘Direct Pay Bill,’ EMS agencies are pushing for support. They call it the right direction to recover from a history of financial troubles. Insurance agencies, however, are fighting back.
EMS groups say getting to this point has been a long-fought battle for them.
“The legislation is really designed to set the expectation those insurers instead reimburse us directly,” Jonathan Smith, Chief of Pittsford Volunteer Ambulance and Chairman of the Monroe County EMS Chiefs Association says.
The ‘Direct Pay Bill’ would require health insurance plans to immediately reimburse ambulance providers across the state when transporting a patient out of network.
It passed unanimously in the House and the Senate. EMS officials say the issue of reimbursement has been what seems like a never-ending cycle, and it’s time for change.
“The ambulance service has evolved significantly over that 60 years and so what we do now is far different than how we were structured at our beginning,” Chief Smith says.
Tim Frost, the Regional Director of AMR in Rochester and Western NY says that the reimbursement confusion has distracted most EMS agencies from what they’re there to do, which he says is serving the community.
“All of the energy that we put into a revenue recovery is again more expense toward and taking away from the general mission,” Frost says. “In the end, we put the patient in the middle. We put the patient in the middle of one distributing dollars that’s sent to them in kind of an erroneous way, but more importantly, we’re adding stressors into their environment.”
Executive Director of the New York Conference of Blue Cross and Blue Shield, Lev Ginsburg says, commercial insurance companies argue that instead of a new law, there’s a simple fix that EMS services can do to avoid legislation.
“The law as it currently states would allow direct payment to ambulance services if they join networks,” Ginsburg says. “There’s simply nothing stopping them from joining networks.”
Chief Smith says if Governor Hochul vetoes the bill, supporters plan to change tactics and continue fighting for something they see value in.
Frost says they understand the position for insurers; however they still need to make up for lost money.
“It still doesn’t change the fact that we provide services and need to recoup the dollars that go into those services,” Frost says.
Insurance representatives say if the Governor signs the ‘Direct Pay Bill’ into law, it may increase premiums for patients.
EMS leaders say they don’t believe that. They add that if the bill is vetoed, it may affect the future of EMS agencies staying in business.
If the Governor does not sign the bill, it will eventually take effect, but not until January of 2025.