Authorizes payments to nonparticipating or nonpreferred providers of ambulance services licensed under article 30 of the public health law

Section 2 amends subparagraphs (c) and (d) of paragraph 24 of subsection (i) of section 3216 of the insurance law stating that the insurers shall send such payments directly to the provider of such ambulance services if the ambulance service includes an executed assignment of benefits form with the claim and the provisions of this paragraph shall apply to transfers of patients between hospitals or health care facilities.

Section 3 amends subparagraphs (c) and (d) of paragraph 15 of subsection (1) of section 3221 of the insurance law stating that the insurers shall send such payments directly to the provider of such ambulance services if the ambulance service includes an executed assignment of benefits form with the claim and the provisions of this paragraph shall apply to transfers of patients between hospitals or health care facilities.

Section 4 amends paragraphs 3 and 4 of subsection (aa) of section 4303 of the insurance law stating that the insurers shall send such payments directly to the provider of such ambulance services if the ambulance service includes an executed assignment of benefits form with the claim and the provisions of this paragraph shall apply to transfers of patients between hospitals or health care facilities.

Section 5. Effective Date.

Justification

The constant and quick availability of ambulance response is something that all of our citizens have grown accustomed to and it is essential to the survivability of all New Yorkers when there is a medical crisis. Fair and direct reimbursement for those services is paramount to the financial stability and continued availability of ambulances to respond.

Current law permits insurance companies to pay for ambulance service charges direct to the patient until and unless the ambulance company becomes a preferred provider of that specific insurance company. It is not practical to expect a preferred provider relationship with every insurance company. But then it is the responsibility of the ambulance company to try to recoup payment for service from that patient.

All types of EMS providers routinely are not paid by the patient for ambulance services even though the patient receives payment from the insurance company. Especially as the financial crisis we are currently facing deepens, more and more patients are pocketing these funds. Further, the insurance company is not obligated to advise the ambulance company that they in fact paid the ambulance transport bill direct to the patient. This disconnect of information leads to confusion and furthers the lack of proper payment issue.

In New York State, ambulance companies are mandated responders. As such, most ambulance providers have no knowledge of the patient's ability to pay or if or by whom they are insured by when a medical emergency or accidental event occurs. Ambulance service is one of the few medical services where payment is not expected at the time of service.

This legislation will assure that responding ambulance service will receive direct payment for all ambulance service transports upon submission of an invoice to the insurance company without the need for the responding ambulance company to be a preferred provider.

Legislative history

S.3542 of 2013-14; S.2714-B of 2011-12; S.4462 of 2010.

Fiscal implications

None.

Effective date

This act shall take effect January 1, 2017 and shall apply to health care claims submitted for payment after such date.