Insurers Fight State Laws Restricting Surprise Ambulance Bills

Nicole Silva’s 4-year-old girl headed for a parent’s house near the city of southern Colorado, Jara, when a vehicle was in the car in which she was driving. A waterfall’s waterfall has followed – an ambulance on the ground at a local hospital, an air ambulance in Denver and another land ambulance at the Colorado children’s hospital.

Silva’s daughter was on Medicaid, who was supposed to cover the cost of ambulances. But one of the three ambulance companies, Northglenn Ambulance, a public company since acquired by a private company, sent Silva’s bill to a debt collector. It was for $ 2,181.60, which increased to more than $ 3,000 with legal costs and interest, according to the judicial archives. The preschool teacher could not pay and the collector garnished Silva’s salaries.

“This has so late on invoices – our payment from the house, electricity, telephone bills, food for children,” said Silva, whose girl was fully recovered from the 2015 accident. “It took everything away.”

Some states legislators seek to limit bills such as the one she has received – surprised by bills for ambulance walks on the ground.

When an ambulance company invoices more than an insurer is not willing to pay, patients can be left with a big bill in which it probably had no choice.

The States are trying to fill a gap left by the federal law on surprises, which covers air ambulances but not ground services, including the ambulances that move by road and water. This year, UTAH and Northern Dakota joined 18 other states that have adopted surprise billing protections for such rides.

These protections often include the definition of a minimum so that insurers can pay if someone they cover need a journey. But the collage point is where to adjust this bar. The legislation of Colorado and Montana has stalled this year because decision -makers feared that forcing insurers to pay more would cause higher health coverage for everyone.

Surprise ambulances bills are an element of a health care system that is systematically sad of Americans with medical debt, maintenance of their finances, preventing them from access to care and increasing racial disparities, as Kff Health News reported.

“If people hesitate to call the ambulance because they fear devoting a huge financial burden on their family, this means that we are going to get stroke victims who do not arrive at the hospital in time,” said Patricia Kelmar, who heads health care campaigns in Pirg, a national consumer defense group. “This means that the person who fears that it is a heart attack will not call.”

The Surprises Act, signed by President Donald Trump in 2020, indicates that for most emergency services, patients cannot be billed for out -of -network care as for the same amount they would have been billed if they were in a network. As doctors or hospitals, ambulance companies can contract contracts with insurers, making it a network. Those who do not remain out of network.

But unlike an appointment with a doctor or planning a surgical intervention, a patient cannot generally choose the ambulance company which will answer its call at 911. This means that they can be struck by large offices.

Federal legislators have heard ambulances on the ground, partly due to the variety of commercial models – from private companies to volunteer fire services – and a lack of data on the cost of journeys.

Instead, the Congress created an advisory committee which issued recommendations last year. Its global conclusion – that patients should not be trapped in the cross -fires between providers and payers – was not controversial or partisan. In Colorado, a measure to extend the protections of laws on surprise ambulances has obtained a unanimous boost in the two legislative chambers.

The Colorado had previously adopted a law protecting people from the surprised bills of private ambulance companies. This new measure was aimed at providing similar protections against invoices for public ambulance services and for transfers between hospitals.

“We knew that it had bipartite support, but there are people who vote not on everything,” said Karen McCormick, pleasantly surprised, a representative of the Democratic State.

A less pleasant surprise came later, when Governor Jared Polis, who is also a democrat, opposed him to his veto, citing the fear of increasing premiums.

States can only do much on this issue, because the laws of states apply only to the health plans regulated by the State. This leaves aside many workers. According to a 2024 national survey by KFF, a non -profit information organization of health information which includes KFF Health News, 63% of people working for private employers and obtain health insurance thanks to their jobs have self -funded plans, which are not regulated by the State.

“This is why we need a federal ambulance protection law, even if we have adopted 50 laws of states,” said Kelmar.

According to data from the Office of the Secretary of State of Colorado, the only lobbying groups registered as “opposite” the bill were Anthem and Unitedhealth Group, as well as the subsidiaries Unitedhealth Optum and Unitedhealthcare.

At the end of the legislative session in May, Kevin McFatridge, Executive Director of the Colorado Association of Health Plans, a commercial group representing health insurance companies in the state, sent a letter to the governor asking for a veto, with an estimate that the legislation would result in an increase of 0.4%.

The Colorado bill said local governments – such as cities, counties or special districts – would set rates.

“We are in a much better place by not making local entities set their own prices,” McFatridge told Kff Health News. “It’s almost like the fox that managed the Henhouse.”

Jack Hoadley, professor of emeritus research at the McCourt School of Public Policy from the University of Georgetown, said that it was not clear if the laws of the state approved elsewhere increase the premiums, or if so, in how much. Hoadley said Washington’s state should release an impact analysis of his law in a few years.

The National Trade Association for Insurance Companies refused to provide a comment for this article. Instead, AHIP transmitted letters that its leaders have submitted to the Ohio, Virginia-Western and Northern Dakota legislators this year, opposing measures in each state to set basic ambulance rates. The management of the AHIP has described proposals as prices inflated and mandated by the government which would reduce the chances of insurers to negotiate fair prices. In the end, warned the association, the minimums offered would increase health care costs.

In Montana, the legislators envisaged a minimum reimbursement for soil ambulances of 400% of what Medicare pays, or at a local rate fixed if we exist. The proposal was sponsored by two Republicans and supported by ambulance companies. Health insurers managed to put pressure against this, arguing that the price was too high.

Sarah Clerget, a lobbyist representing AHIP, told Montana legislators during a legislative hearing that it is already difficult to ensure that ambulance companies perform with insurers, “because people will need ambulance care, that their insurance company will cover it.” She said that the state’s proposal would leave those who would pay for health coverage with the burden of the new price.

“None of us love our insurance rates,” said Republican State Senator Mark Noland at a legislative meeting as a committee tabled the bill. He assimilated the minimum proposed to a mandate that could lead people to pay more for health coverage for important but nevertheless niche service.

The governor of Colorado was also focused on bonuses. Polis said in his veto letter that the legislation would have increased bonuses between 73 cents and $ 2.15 per member per month.

“I agree that filling this gap in the application is crucial to save money from health care,” he wrote. “However, these cost savings are offset by my opinion by the increases in bonuses.”

Isabel Cruz, director of policies at Colorado Consumer Health Initiative, who supported the bill, said that even if bonuses increased, coloradans could agree with change. After all, she said, they would exchange the threat of a large ambulance bill for the price of half a cup of coffee per month.

Kff Health News is a national editorial hall that produces in -depth journalism on health issues and is one of the main KFF operating programs – an independent source of independent research, survey and journalism. Learn more about KFF.

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