Nov. 21—ALBANY — Ambulance operators in New York will have an easier time collecting their payment from insurance companies, thanks to a law signed Friday by Gov. Kathleen C. Hochul.
The "EMS Direct Pay Bill" forces insurance companies operating in New York to reimburse EMS providers for transporting their patients even if those providers don't have a formal relationship with the insurer. It takes effect on Jan 1, 2025.
Under the law as it was before Friday, and will remain until 2025, insurance companies are allowed to pay the costs of an ambulance ride to the customer unless they'd established a "preferred provider" relationship with the EMS provider. The EMS group then had to bill the customer, who was expected to hand the money from their insurance company over to the EMS operator. That didn't always happen, leaving EMS providers with an unpaid bill, which could be a significant proportion of a EMS provider's costs.
"For the year of 2022, there was over $93,000 in checks that didn't make it to Guilfoyle," said Jeff Call, chairman of the United New York Ambulance Network, general manager of Watertown's Guilfoyle Ambulance Service and Chief of Operations for the Cape Vincent Ambulance Squad. "That's nearly $100,000 in checks not cashed, and for the company that does billing for (Guilfoyle), their client base alone it was close to $4 million," he said.
Now, regardless of if the EMS provider has a relationship with the EMS provider, the insurance company will be required to pay the provider directly.
Call said EMS advocates have been fighting for years to have this bill passed, but have seen pushback from insurance companies who have said it will drive up premiums. He said he doesn't get that argument.
"They're already writing the checks," he said. "They're writing the checks and sending them to customers, so the money is going out. The only thing we're asking is that they take the customer out of the middle and they give us the money."
He said every EMS operator bills what is known as a "usual and customary rate," which is mandated by law and requires that EMS operators bill a standard rate as listed on their chargemaster, or list of services and their associated price. This usual and customary rate was required regardless of how the EMS provider is paid, and regardless of its relationship with the insurance company being billed.
Call said the insurance company lobbyists had pitched a clause that would implement direct pay but tie private insurance prices to Medicare rates. He said that would have been dismal for EMS providers, as Medicare pays EMS providers less than the costs they incur for doing business.