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New Wisconsin bill targets surprise ground ambulance bills
In most cases, Americans are protected from surprise medical bills. In Wisconsin, ground ambulance rides are the notable exception.
WAUKESHA, Wis. - In most cases, Americans are protected from surprise medical bills. In Wisconsin, ground ambulance rides are the notable exception. But a new bill aims to help consumers and struggling ambulance providers.
New bill in the works
The backstory:
Since 2022, The No Surprises Act has protected patients from out-of-network balance bills in medical emergencies. It also protects against balance bills for care provided by out-of-network doctors at in-network facilities.
As Wisconsin ambulance providers know well, the No Surprises Act did not address ground ambulance rides.
"There were just way too many complexities to include (ground ambulances)," said Scott Mickelsen, Director of Client Services for Bell Ambulance, of The No Surprises Act. "Unfortunately, the consumer gets put in the middle."
Mickelsen says most ground ambulance services are out-of-network with insurance companies.
History of complaints
Dig deeper:
Asa result, Wisconsin consumers might see a gap of hundreds, even thousands of dollars, between what their ambulance provider charges and what their insurance covers. Rates vary from one ambulance provider to the next.
"I don't blame (riders) for being upset," said Mickelsen. "(They say) I had insurance. Why am I getting this bill?"
It's a complaint Contact 6 has heard about insurers and ambulance providers over the years, including Illinois-based Superior Ambulance. Superior's customers said they were left on the hook for thousands of dollars after insurance chipped in.
Superior Ambulance did not respond to Contact 6's request for comment on the new bill.
Ambulance provider reacts
What they're saying:
Bell Ambulance has 13 stations in southeast Wisconsin and more than 80 vehicles. Mickelsen says they've wanted legislation addressing surprise ambulance bills for more than three years.
"In Wisconsin, this is the farthest we've gotten," said Mickelsen of the bipartisan bill.
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Mickelsen is also a board member for the Professional Ambulance Association of Wisconsin (PAAW).
What the bill says
What we know:
"I think on both sides, there's a compromise here," said Rep. Tony Kurtz (R-Juneau County) who introduced the bill, of ambulance providers and insurance companies.
Kurtz's bill makes several changes to the reimbursement of emergency ambulance rides by health insurance plans.
Among the changes: network plans would be required to cover emergency ambulance services at a rate more than three times what Medicare covers. Mickelsen says the current Medicare rate is well below the actual cost of care.
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"In general (the reimbursement) would be higher than most insurance companies are paying now," said Mickelsen.
Broader look
Big picture view:
22 other states have already passed protections from surprise ambulance bills, including both red and blue states.
Under the bill, Wisconsin's rate for EMS services would be 350% of the federal Medicare rate in communities without an established reimbursement rate. Texas law sets minimum rates at 325%. Indiana's minimum rate is 400%.
One trade association that supports health plans says it wants to protect patients from surprise ambulance bills, but says Wisconsin's legislation would mean higher insurance costs.
"Individuals who have health coverage should not be charged by ambulance companies simply because that ambulance company does not wish to negotiate rates with health plans," said John Nygren, CEO of the Wisconsin Association of Health Plans.
Nygren goes on to say, "this bill sets an arbitrary and often above-market rate for ambulance services, which would inflate costs for patients and consumers."
Mickelsen says an increased reimbursement rate from insurance would not only help consumers, but an industry struggling with increased costs and razor-thin margins.
Rep. Kurtz believes the bill will also help ambulance response in rural parts of the state.
What's next:
The Wisconsin Assembly Committee on Health, Aging and Long Term Care held a public hearing on the bill on Wednesday, Jan. 7.
The Source: Information for this report comes from AB720, The No Surprises Act, Bell Ambulance, the WI Association of Health Plans and prior Contact 6 reporting.