This story was originally produced by the Concord Monitor. NHPR is republishing it in partnership with the Granite State News Collaborative.
An independent study of ambulance trips in New Hampshire says that each call costs between $414 and $2,317, not including mileage, depending on level of care and where they take place.
The analysis, done for the New Hampshire Insurance Department, is part of a long-running effort to standardize charges by the state’s many private and municipal ambulance companies as well as deal with surprise or balance billing, in which patients have to pay the difference between insurance coverage and ambulance company charges.
“Consumers are very confused. For a lot of them it’s a huge financial lift and a lot of confusion about why they’re getting this bill if they have health insurance coverage,” said D.J. Bettencourt, the state’s insurance commissioner.
Ambulances are not covered by recent state law that aligns with the federal No Surprises Act to reduce the change of extra charges coming after a medical procedure. The state legislature told the Insurance Department to conduct this study as a step toward dealing with the situation.
Several bills related to ambulances have been introduced for the upcoming legislative session.
The study, conducted by Public Consulting Group and released this week, emphasized how erratic the situation can be.
“There is no current rate; for commercial plans it’s all over the place. That is part of what we saw,” said Michelle Heaton, director of life and health for the insurance department.
The study estimated fair rates for 10 types of coverage, from basic EMS treatment in which the patient is not transported through specialty care transport for patients in critical condition being taken to a different facility for special treatment. Each was studied for three types of regions: urban, rural and “super rural,” which basically meant Coos County.
Specialty care was a little more than four times as expensive as basic treatment without transport. There was just a slight difference in rates between urban and rural but super rural rates were about one-quarter to one-third higher.
The study said recent data said median EMS bills had reached $3,570, meaning half were less expensive and half were more expensive.
“The rates that are being proposed would cover the total cost for these services plus a 2% operating margin,” Heaton said. “This is just one of the pieces of the puzzle. … It’s not going to solve all of the problems of ground ambulances in New Hampshire.”
The rates in the report are slightly more than twice the base rate reimbursed by Medicare. EMS bills for non-Medicare patients have traditionally covered at least some of that shortfall.
“We understand that commercial insurers need to increase their rates. But the ambulance providers need to analyze their current business model and appreciate they have to make reforms to make it more efficient, to make it financially sustainable for the long run,” said Bettencourt.
The insurance commissioner said the study should help negotiations between EMS providers and insurance over putting ambulances within insurance networks, reducing surprise bills when a transport is not part of a patient’s insurance coverage.
“We hope the study will generate more agreement for providers to come into network so there is certainty for what the provider can expect from commercial insurance carriers,” he said.
The study said has 161 licensed Emergency Medical Service (EMS) units that include ambulances, about two-thirds of which are based with municipal fire departments and a quarter of which are private but not based at a hospital, with AMR being the largest.
The number of trips taken each year varies widely. Seven EMS units do fewer than 100 transports a year while six do more than 7,500 a year. Most perform between 100 and 3,000 transports per year.
The study calculated an average net cost that was offset by the local tax revenue earmarked for EMS, with the average net cost divided among transport and treating without transport responses, and mileage. About 80% of costs are related to personnel, 67% of which is on-ambulance staff.
The study estimates that if these rates were used they would result “in a commercial premium increase of 0.1%, which equates to $4.3 million total per year or (36 cents) per member per month.”
The New Hampshire Ground Ambulance Cost Study Final Report is available on the New Hampshire Health Plan website at nhhp.org.
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