As financial pressures impinge the health care system, the various players sometimes seek legislation to protect their interests. I have heard of two such situations in Massachusetts, and I offer them for your consideration and your comments.
The first involves emergency ambulance service. Earlier this year, several of the major insurers in the state stopped reimbursing out-of-network ambulance providers, and instead started to send the checks to patients who used those ambulances. Those ambulance companies now have to try to collect from people for payments, and they are losing hundreds of thousands of dollars.
(This only relates to emergency calls, not routine transfers. For routine transfers, ambulance providers already agreed to be reimbursed at agreed-upon rates with insurers and municipalities.)
I can understand why the insurers want to use lower cost ambulance services, but I have trouble imagining a more cruel thing than approaching a patient or a patient’s family after an emergency situation (which perhaps led to long-lasting disability or death) to collect funds that the insurers have sent to the family. It is also inherently inefficient and adds costs if the ambulance companies have to try collect funds from hundreds of individual patients rather than the few insurance companies.
Rep. Jim Cantwell of Marshfield has filed a bill to force insurers to pay EMS providers, and it has a cost-control provision that would give ultimate rate-setting power to local selectmen. The Fire Chiefs Association, Massachusetts Municipal Association and Massachusetts Hospital Association support this bill. This sounds like one that, in legislative parlance, “ought to pass.”
Then there is a proposal that comes out of the growth of tiered networks, in which insurers charge higher co-pays or otherwise limit coverage to patients who choose higher cost providers. Well, it turns out that some of those high-cost providers are seeking legislation that would require insurers to include them in the low-cost tier of the network. The two fields at play are pediatrics and cancer care. The providers’ argument is that they offer essential services not available at other providers, or that they offer similar services but at higher quality.Continue reading…
