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https://www.nysac.org/news/posts/counties-legislators-unveil-legislative-package-to-rescue-ems/

Counties, Legislators Unveil Legislative Package to ‘Rescue EMS’ Legislation will help fund local EMS, attract and retain EMS professionals and increase Medicaid reimbursements

6/10/23

Colleagues:

DIRECT PAY BILL APPROVED BY BOTH NYS ASSEMBLY & SENATE
S1466 Breslin / A250A Magnarelli

The New York State Senate and Assembly have both unanimously approved “Direct Pay” legislation that has been a top NYSVARA and United New York Ambulance Network (UNYAN) priority for several years. The bill will now be forwarded to the Governor for signature into law.

This legislation will ensure that ambulance providers receive direct payment for services upon submission of a claim to the beneficiary’s insurance company, without the ambulance company needing to be a “preferred provider.” We are grateful to Senator Breslin, Assemblymember Magnarelli, and their colleagues for passing this legislation.

This legislation will allow ambulance services to be directly paid by insurers, dramatically simplifying the revenue collection process. Currently, when a patient uses an ambulance service that is not a “participating” or “preferred” provider with their insurance company (out-of-network), their insurance company sends the reimbursement check directly to the patient. While the patient is then expected to pay the ambulance provider, in many cases, the patient cashes the check and does not pay the ambulance provider, forcing extensive collection activities.

Insurance companies had tried to use this legislation to force all ambulance services to become in-network providers and accept significantly discounted reimbursement rates. Fortunately, those provisions were not included in the final legislation.

NYSVARA believes that fair and direct insurance reimbursement for EMS calls is paramount to financial stability and continued availability of ambulance services to serve our patients and communities. Volunteer EMS responders report to shifts around the clock and are at the ready to assist the ill and injured. Signing this legislation into law will help ambulance squads by increasing the percentage of the payment intended for ambulance service that actually gets to the ambulance squad. NYSVARA and our partners at UNYAN will strongly urge Governor Hochul to sign this bill into law.

Steve Kroll, Legislative Chairman
Henry Ehrhardt, President
Teresa A. Hamilton, Executive Vice President
Mark Deavers, Vice President
[email protected]

New York State Volunteer Ambulance & Rescue Association, Inc. Non-Profit Association representing volunteer EMS professionals and organizations throughout New York State.

Lets see what this stirs up shall we.
I joined EMS back in 1997 when the general public was happy to greet you at the door in their time of need. They didn't care if you had a uniform on or shorts and a T-shirt. Fast forward to 2023 and I hear everyone complaining about how EMS didn't get there fast enough or all that was done was a blood pressure and a ride to the hospital, and It takes everything I have to not post on these "bloggers" sites because I have to maintain a neutral position. I will however make some statements on a few subjects with regards to EMS. This is only my opinion, and the facts may vary from state to state, and I can only express my opinion based on my experiences as a past paramedic and in no way is meant insult any persons or their roles in public safety.

1. Why do we as a society place a higher value on property than our lives and health? If we placed the same value on our lives, then I would be willing to bet that the EMS service would have the same benefits and financial support from our governments as does the fire departments and police departments. Ask yourselves how much in taxes you pay each year for fire protection but when EMS is looking for support, we cry about paying more in taxes.

2. Insurance payments- Let's get a few things clear.

Medicare has a maximum allowable amount they will pay MINUS and co-pays or deductibles. This means that on a plan with a $200 co-pay, a maximum allowable amount of $400 and a bill that costs $1000, Medicare will only pay the ambulance provider $200. You as the patient is responsible for the remaining $200 and by law we cannot collect on the balance.

Medicaid - Follows the same rule, except there are no deductibles and if Medicaid pays $200, that's it. You do not get more than that and cannot bill for the difference.

Private (non Medicare plans) - If and only if you have met your deductible is when the ambulance will receive payment for the full $1000. And even then, if the ambulance is a non-par or out of network provider the insurance will send the payment to the patient and the ambulance now has to try and collect that from the patient direct.

3. EMS is not your local restaurant where you complain about your service means you're going to get a free meal. You chose your insurance plan and if you have a high deductible or co-payment, then take responsibility and pay it.

4. Understand that EMS is either ALS or BLS with a few variations in-between.
ALS = Advanced Life Support. This is where the Paramedic who has far greater training and is experienced in medication administration, EKG interpretation, pain management and a whole slew of other things that would make the average person ask why they didn't just go to med school and most likely your condition at the time of dispatch has a potential to be life-threatening.

BLS = Basic life support. Don't expect a drive to the hospital with lights and sirens as this level of care means your condition is most likely non-life-threatening.

Balanced billing - I'm not even going to dive into this one because everyone seems to think they know more than everyone else. Read the balance billing laws is my best advice.

EMS is overworked, understaffed and underappreciated among other things but most importantly most if not all of them love what they do and that's why they do it. Don't penalize an entire system and your community simply because you're not happy with things. Ask your community representatives, local EMS agencies and everyone else you can think of and be a part of the solution.

There is a whole set of rules and regulations that need to be followed for EMS services both for billing guidelines as well as local state and federal patient care protocols that must be followed, and although we do not have all the answers, we can point you in the right direction if you wish.

Now I must apologize for my rant and hope you all have a great and safe weekend. Remember to pull over for Emergency vehicles with lights and sirens. :)

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