Insured patients still receive unexpected out-of-pocket costs after ground ambulance rides, but the providers of these rides have been left out of federal surprise-billing proposals, according to The New York Times.
Surprise medical bills occur when an insured patient visits an emergency room and unintentionally receives care from a provider that is not in their insurance company's network. This often occurs when the hospital is in-network and the provider is not.
Congress is considering proposals to address the issue. However, ground ambulance rides — the largest source of unexpected out-of-network medical bills, according to research by Christopher Garmon, a health economist at the University of Missouri-Kansas City — is left out of the legislation, according to the Times.
Mr. Garmon's research, published in Health Affairs, found that more than half of bills for ground ambulance rides are out of network, compared to 19 percent of emergency room visits.
A Senate surprise-billing proposal, formally introduced June 19 by Sen. Lamar Alexander, R-Tenn., and Sen. Patty Murray, D-Wash., addresses air ambulance surprise-billing. Among other things, it would limit patients' out-of-pocket costs for air ambulance transportation to the in-network cost-sharing amount and prohibit air ambulance providers from balance-billing patients for an amount exceeding the in-network cost-sharing amount.
Mr. Alexander told the Times the bill does not extend to ground ambulance rides because states are able to regulate those rides, but not air ambulances.
Patient advocates contend that competing interests of hospitals, physicians and health plans have made it challenging for states to address ground ambulance billing in legislation, and a lack of state-level fixes to address the issue has been a hurdle to addressing it at a federal level, according to the newspaper.
Read the full Times report here.
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