ROCHESTER, N.Y. (WROC) — The “Direct Pay Bill,” which has already passed both sides of the House and is now before the Governor, would require health insurance plans to immediately reimburse ambulance providers when transporting a patient with coverage outside their network.
The majority of EMS agencies in Monroe County are considered out of network. As the policy stands, first responders don’t always see the payments sent to the patient from an insurer right away, or in some cases, at all.
Those in health care, however, are fighting against this. Some say it’s in an effort to keep future rates low for their patients.
Last year, CHS Mobile Integrated Health Care accrued nearly half a million dollars in what officials call ‘kept checks,’ or checks sent to patients never seen by the agency for ambulance transportation.
“We try to chase the patients. We can take them to collections, things like that, but there’s not a lot of options to recoup this money from them,” said Frank Manzo, chief & CEO of CHS Mobile Integrated Health Care.
If the bill passes, it would regulate cost control for health insurance plans billing patients out of network. Instead, insurers would be required to reimburse ambulance providers immediately.
“What this ultimately does is it strips insurance plans of the opportunity to create networks of ambulance providers to provide the best service or guarantee the best service at the best price for their customers and their enrollees.. Like all things in health care, there’s significant expense and what insurance plans try to do is try to mitigate that expense as much as possible for the consumer,” said Lev Ginsburg, executive director for the New York State Conference of Blue Cross and Blue Shield Plans.
At a time when the EMS field remains stretched, due to staffing and general finances, Manzo says ultimately, accountability on patients is needed.
“Our problem we have today without direct pay in place is that we don’t always see the money that is sent to the patient. That is truly ours. We provide for the service, we billed for the service, they have insurance that covers that service, and the expectation is we get paid for the service,” said Manzo.
Gov. Hochul has until the end of the year to sign or veto the bill. News 8 has reached out to the governor’s office for comment and has not gotten a response.
If passed, the legislation would take effect in January 2025.