Relates to reimbursement for ambulance services

9 Co-sponsors

• Joseph P. Addabbo Jr.
• John A. DeFrancisco
• Patrick M. Gallivan
• Terry Gipson
• Michael F. Nozzolio
• Michael H. Ranzenhofer
• Patty Ritchie
• Joseph E. Robach
• Diane J. Savino

BILL NUMBER:S3541

Title of bill

An act to amend the insurance law, in relation to reimbursement for ambulance services

Purpose

To require insurers to submit payments directly to ambulance providers who are in-network or, for out-of-network ambulance providers, to require the issuance of a joint check to the insured specifying both the insured and the ambulance provider as payees.

Summary of provisions

Amends sections 3216(i)(24), 3221(1)(15) and 4303(aa) to require insurers to submit payments directly to in-network ambulance providers at the negotiated rates For out-of-network ambulance providers where there is no negotiated rate, the insurer is required to issue a joint check to the insured specifying both the insured and ambu- lance provider as payees, at the usual and customary charge.

Further, the legislation requires the insurer to issue reimbursement directly to the ambulance provider if the insured has filed an assign- ment of benefits for such ambulance services.

The legislation also requires the insurer to notify the ambulance provider electronically upon the issuance of a joint check to the insured. The notification must include the name of the patient, date of service, date of payment, amount of payment and address to which the payment was sent.

Justification

This bill would amend the insurance law to require insur- ers to issue joint signature checks to both the patient and ambulance service provider when the patient utilizes an ambulance service provider that is a non-participating provider of their network.

Currently, when a patient uses an out-of-network ambulance provider, their insurance company will send the ambulance reimbursement payment directly to the patient. The patient is then expected to forward that reimbursement payment to the ambulance service that provided the service. In many cases with a single signature check, the patients never send the insurance reimbursement to the service provider. Rather, they keep the money for themselves, diverting millions of dollars from our healthcare system in the process.

This bill would insure that healthcare dollars stay in the healthcare system and that healthcare providers are paid for the work that they do. In order to cash the check, both parties would need to endorse the check. Insurers would send the joint signature check to the patient, the patient would sign it and send it to the ambulance provider The ambu- lance provider could then endorse the check and be paid for their service. The insurer will also notify the ambulance provider when a joint signature check has been sent to the patient.

Ambulance providers are mandated responders who must provider service when an emergency call comes in. They answer these calls without know- ledge of a patient's ability to pay and without concern of getting paid at the time of service But in order to keep the ambulance system strong and viable they must collect payment for service. This bill would assist in collecting payments.

Legislative history

S.6982 of 2012

Fiscal implications

None.

Effective date

Immediately.