Bill to Require Direct Pay to Ambulance Services Heads to Governor’s Desk, Causer Says
HARRISBURG – Rep. Martin Causer (R-Turtlepoint) today announced the passage of legislation that will finally require insurance companies to directly pay ambulance companies, rather than patients, for transport services. The bill is awaiting the governor’s signature to become law.
Currently, insurers send reimbursements to patients with the expectation they will pass the money on to the ambulance company, but in many cases that does not happen.
“At a meeting we held earlier this year in Port Allegany to discuss the challenges facing our rural ambulance services, this was one of the major financial concerns raised,” Causer said. “While this change will not solve the financial problems of our emergency service organizations, it is a significant step in the right direction.”
Under
House Bill 857, insurance companies would be required to pay directly to a non-network EMS agency for a service performed by that agency, as long as it was properly dispatched by a public safety answering point and provided medically necessary care.
To qualify for direct payment, the EMS agency would have to submit a standardized form developed by the Department of Health that contains the agency’s list of insurers from whom it has agreed to receive direct payment. When submitting a claim, the agency would have to notify the insurer that it is registered to receive direct payment.
Finally, the law would prohibit EMS agencies from balance-billing patients for services provided. It can still recover a copay, deductible or co-insurance.
The law would take effect in January 2016.
Causer noted House Bill 857 also reauthorizes the state’s Children’s Health Insurance Program (CHIP), which provides no-cost or low-cost health care coverage for children, helping to improve the overall health of those under age 18. Any child not eligible for Medical Assistance is eligible for CHIP, with monthly premiums based on family income. More information about CHIP is available online at the
Pennsylvania's Children's Health Insurance Program.
Representative Martin T. Causer
67th District
Pennsylvania House of Representatives
Media Contact: Patricia A. Hippler
717.772.9846
phippler@pahousegop.com
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