Congress passed the ‘No Surprises Act,’ which prohibits most surprise out-of-network billing for plan years beginning in 2022. Surprise bills occur when a patient receives care from an out-of-network provider or facility during an emergency visit or while receiving non-emergency care at an in-network hospital or facility.
In these cases, patients may face balance billing from the out-of-network provider for the difference between the provider’s charged amount and the plan’s allowed amount for that service.
In this blog, we discussed ambulance use, ownership type, the share of ground ambulance rides with potential for surprise bills, and state or local policies aimed at reducing surprise bills for ground ambulances.
Some of facts related to ambulance surprise bills are as follows:
- Ambulances bring 3 million privately insured people to an emergency room each year.
- Local fire departments and other government agencies provide nearly two-thirds (62 percent) of emergency ground ambulance rides.
- Around 51 percent of emergency and 39 percent of non-emergency ground ambulance rides included an out-of-network charge for ambulance-related services that may put privately insured patients at risk of getting a surprise bill.
- In seven states (Washington, California, Florida, Colorado, Texas, Illinois, and Wisconsin), over two-thirds of emergency ambulance rides included an out-of-network charge for ambulance-related services that may pose a surprise bill risk.
Exclusion of Ground Ambulances from No Surprises Act
The No Surprises Act will prohibit most surprise bills, reducing out-of-pocket costs for emergency services and non-emergency services where the patient unintentionally sees an out-of-network provider. Congress did not include ground ambulances in the No Surprises Act reportedly because so many emergency medical transport services are operated by municipal and county governments, and therefore, may be subject to additional types of state and local regulation. Congress expressed interest in revisiting surprise billing for ground ambulances once it gathers more information.
One-in-ten emergency room visits for privately insured patients begin with an ambulance ride. Similar to other studies, we find that about half of emergency ground ambulance rides for large group enrollees include an out-of-network charge for ambulance-related services that may put people at risk of getting surprise bills.
Taken together, as many as 1.5 million privately insured patients who are brought to an emergency room by an ambulance may be at risk of getting a surprise medical bill each year.
Where there is state or local regulation of ground ambulance billing practices, those laws may protect only certain types of ground ambulance rides. State laws protecting patients from surprise out-of-network ground ambulance bills do not apply to self-insured health plans.
The No Surprises Act requires the federal government to convene an advisory committee of federal and state officials, emergency medical services providers, and consumer representatives.
Role of Local Government
In the absence of federal laws protecting patients from ground ambulance surprise bills, states and local governments play varying roles in regulating ground ambulance patient billing and insurer payments. There are two types of state laws that are important here: laws that regulate ambulance providers and laws that regulate how insurers treat claims from ambulance providers.
While states cannot regulate the self-funded health plans that cover about two-thirds of workers in the U.S. (typically those employed at larger companies), state governments do regulate health insurers selling fully-insured coverage. Many states specifically protect patients from getting a ground ambulance surprise bill from providers. However, some of these state regulations only apply to a subset of ground ambulance agencies.
State and local laws vary in whether ground ambulance service providers or health plans are regulated and types of ground ambulances that are prohibited from balance billing patients. For example, Delaware has regulations on out-of-network payment dispute resolution process for health plans and providers of emergency services, which specifically include ground ambulances.
Medical Billers and Coders (MBC) is a leading medical billing company providing complete revenue cycle solutions. We have discussed the exclusion of ground ambulances from the ‘No Surprises Act’ as an insight into proper ambulatory billing. If you need any assistance in billing for your ambulatory services, contact us at info@medicalbillersandcoders.com / 888-357-3226
FAQs:
1. What is the No Surprises Act?
The No Surprises Act prohibits most surprise out-of-network billing for plan years beginning in 2022, protecting patients from unexpected medical bills when they receive care from out-of-network providers during emergencies or at in-network facilities.
2. Why are ground ambulances excluded from the No Surprises Act?
Ground ambulances are excluded due to the fact that many are operated by municipal and county governments, which are subject to different state and local regulations. Congress may revisit this issue as more information becomes available.
3. How many patients are at risk of surprise bills from ambulance rides?
Approximately 1.5 million privately insured patients who are transported by ambulance to emergency rooms may face surprise medical bills each year due to out-of-network charges.
4. What roles do state and local governments play regarding ambulance billing?
States and local governments regulate ground ambulance billing practices and insurer payments. Some state laws protect patients from surprise bills, but these regulations vary and may not cover all ground ambulance services or self-insured health plans.
5. What constitutes a surprise bill in the context of ambulance services?
A surprise bill occurs when a patient receives care from an out-of-network ambulance provider or facility, leading to charges that exceed what their insurance plan covers, often without prior knowledge.
