State laws to stop surprise ambulance accounts are confronted with Pushback from Insurers

Nicole Silva’s 4-year-old daughter was on his way to the house of a family member near the southern city of Colorado, La Jara, then a vehicle the car in which she drove. A cascade of ambulance rides followed a ground ambulance to a local hospital, an air ambulance for Denver, and another ground ambulance in the hospital of children.

Silva’s daughter was on Medicaid, who should cover the costs of the ambulances. But one of the three ambulance companies, Northglenn ambulance, a public company since then Acquired by a privateSent the bill from Silva to a debt collector. It was for $ 2,181.60, which grew to more than $ 3,000 with court costs and interest, according to judicial data.

The preschool teacher could not pay and the collector garnished Silva’s wages. “It put us in the back of accounts – our home payment, electric, telephone accounts, food for the children,” said Silva, whose daughter was fully recovered from the 2015 crash. “It took everything away.”

Some state laws want to curb bills, such as the person who received them – surprise accounts for ground ambulance journeys.

If an ambulance company charges more than an insurer is prepared to pay, patients with a large account can be left in which they probably had no choice.

States try to fill in a gap that has been left by the federal No surprisesThose air ambulances comprises, but no ground services, including ambulances that travel on road and water. This year Utah and North Dakota have become a member 18 Other States who have assumed the protection against surprise invoicing for such journeys.

These protections often include setting a minimum for insurers to pay out if someone they cover needs a ride. But the bottleneck is where that beam can be set. Legislation in Colorado and Montana stopped this year because policy makers were worried that forcing insurers to pay more would lead to higher costs for health for everyone.

Surprising ambulance accounts are a piece of a health care system that systematically saddles Americans with medical debts, taxing their finances, preventing them from gaining access to care and increasing racial differences, as KFF Health News has reported.

“If people hesitate to call the ambulance because they are concerned about laying a huge financial burden for their family, this means that we will get victims of strokes who will not come to the hospital on time,” said Patricia KelmarThose health care campaigns sends a national interest group for consumers at Pirg. “It means that the person who worries that it can be a heart attack will not call.”

Challenges for passing protection in Colorado

The No Surprises Act, signed by President Donald Trump in 2020, says that patients can only be invoiced for most emergency services for care outside the network for the same amount that they would be invoiced if it were in the network. Just like doctors or hospitals, ambulance companies can contract with insurers, making them in the network. Those who do not stay outside the network.

But unlike making an appointment with a doctor or planning an operation, a patient cannot generally opt for the ambulance company that will respond to his 911 call. This means that they can be touched with large bills outside the network.

Federal legislators have caught when taking out ground ambulances, partly due to the variety of business models – from private companies to voluntary fire brigades – and a lack of data on how many journeys cost.

Instead, the congress created one advisory committee That made recommendations last year. The umbrella conclusion – that patients should not be held in the crossfire between providers and payers – was not controversial or biased. In Colorado, a measure Focused on expanding the protection against surprise ambulance accounts, a unanimous thumb was raised in both legislative rooms.

Colorado had earlier has adopted a law Protect people against surprise accounts against private ambulance companies. This new measure was aimed at providing comparable protection against accounts of public ambulance services and to transfers between hospitals.

“We knew it had dual support, but there are people who do not vote for everything,” said a pleasantly surprised Karen McCormickA representative of the Democratic State.

A less pleasant surprise came later, then Gov. Jared Polis, who is also a democrat, spends veto, with reference to the fear of rising premiums.

States can only do so much about this issue, because national laws only apply to health plans regulated by the state. That omits many employees. By one 2024 National Survey by KFF, a non -profit organization for health information with KFF Health News, 63% of people who work for private employers and receive health insurance through their work Self -financed plansthat are not regulated by the state.

“That is why we need a federal ambulance protection law, even if we have hired 50 state laws,” said Kelmar.

According to data from the State Secretary of Colorado, the only lobby groups registered as “opponent” The bill was Anthem and UnitedHealth Group, plus subsidiaries of UnitedHealth Optum and UnitedHealthcare.

As soon as the legislative session ended in May, Kevin McFatridgeexecutive director of the Colorado Association of Health Plans, a trade group that represents health insurance companies in the state, sent a Letter to the governor Requesting a veto, with an estimate that the legislation would result in premiums of 0.4%.

The Bill Colorado said that local authorities – such as cities, provinces or special districts – would determine rates.

“We are in a much better place by not having local entities determine their own rates,” McFatridge told KFF Health News. “That is almost as if the fox manages the chicken coop.”

Resistance of the insurance sector

Jack HoadleyAn emeritus research professor at the McCourt School of Public Policy of Georgetown University, said it is not clear whether the state laws approved elsewhere are raising premiums, or, if so, by how much. Hoadley said that the state of Washington is expected to appear an impact analysis of his law in a few years.

The National Trade Association for Insurance Companies, AHIP, refused to give a comment for this article. Instead, AHIP sent letters through who submitted its leaders to legislators In Ohio” West VirginiaAnd North Dakota This year opposite measures in every state to set up basic ambulance figures. AHIP leadership described the proposals as blown up by the government mandated prices that would reduce the chance of insurers to negotiate fair prices. Ultimately, the association warned, the proposed minima would increase the costs of health care.

In Montana, Wetgevers were considering A minimal reimbursement for land ambulances of 400% of what Medicare pays, or at a fixed local rate if there is one. The proposal was sponsored by two Republicans and supported by ambulance companies. Health insurers successfully lobbying and claimed that the price was too steep.

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

“None of us love our insurance rates to move,” Republican State Sen. Mark Noland said during a legislative meeting as a committee submitted the bill. He set the proposed minimum to a mandate that could lead to people paying more for health coverage for an important yet niche service.

The Governor of Colorado was focused on premiums in the same way. Said policy in his Veto letter that the legislation would have increased premiums between 73 cents and $ 2.15 per member per month.

“I agree that filling in this gap in enforcement is crucial to save people money on health care,” he wrote. “These cost savings are, however, growth against my opinion by the premium increases.”

Isabel CruzPolicy director at the Colorado Consumer Health Initiative, which supported the bill, said that even if the premiums were to rise, colorad dance might be in order with the change. After all, she said, they would trade the threat of a large ambulance account for the price of half a cup of coffee per month.

KFF Health News is a national newsroom that produces in -depth journalism about health problems and one of the core activities is at Kff.