New Bill Aims to Improve Health Insurer and EMS Billing

A new law is being suggested to make it easier for health insurance companies and emergency medical service (EMS) agencies to handle their billing processes. 

In Rochester, New York, there is a new law called the "Direct Pay Bill" that has already been approved by both sides of the House and is now waiting for the Governor's approval. 

Bill Aims to Improve Health Insurer and EMS Billing

This law would make health insurance plans pay ambulance providers right away when they transport a patient who has insurance coverage outside of the ambulance provider's network.

Most emergency medical service (EMS) agencies in Monroe County are not part of the insurance networks. Currently, when they provide medical services, they don't always receive the payment from the insurance company immediately, and sometimes they never get paid at all.

People working in the healthcare industry are opposing this bill. They believe it could lead to higher costs for patients in the future if the insurance companies have to pay ambulance providers right away.

For example, last year, CHS Mobile Integrated Health Care faced a problem where they didn't receive nearly half a million dollars for ambulance services because the checks were sent to the patients instead of the agency.

Frank Manzo, who is the chief and CEO of CHS Mobile Integrated Health Care, explained that they try to contact the patients to get the payment, but it's challenging, and there aren't many options to get the money back.

If the "Direct Pay Bill" is passed, it will make sure that health insurance plans pay ambulance providers promptly, even if the ambulance service is outside of their network. This will help regulate the costs of health insurance plans and ambulance services.

"What this new law does is take away the ability of insurance plans to build networks of ambulance providers that offer the best service and prices to their customers. 

In the healthcare industry, there are significant costs, and insurance plans try to reduce those costs as much as possible for their customers," explained Lev Ginsburg, who is in charge of the New York State Conference of Blue Cross and Blue Shield Plans.

Currently, the EMS field is facing challenges with staffing and finances. Frank Manzo expressed that they need more accountability from patients. Without the direct pay system in place, sometimes the ambulance providers don't receive the money they are owed for the services they provided to patients. 

They expect to get paid because they have been given the necessary medical care, billed for it, and the patient's insurance should cover it.

The Governor, Gov. Hochul, has until the end of the year to decide whether to approve or reject the bill. News 8 has tried to get a comment from the Governor's office but has not received a response yet.

If the bill is approved, it will become effective in January 2025.

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