This story was originally produced by the Concord Monitor. NHPR is republishing it in partnership with the Granite State News Collaborative.
New Hampshire will soon prohibit “surprise billing” by ambulance companies requiring patients to cover costs for an ambulance ride that health insurance won’t, but the thorny question of financing emergency medical transport has not been solved, especially in rural areas.
On Thursday, Gov. Ayotte signed Senate Bill 245, which goes into effect next year. It prohibits surprise billing by ambulances, sometimes called balanced billing, and boosts insurance companies’ standard reimbursement for ambulance trips to 325% of the federal Medicare rate.
As if to emphasize the need for action, a week ago the Warren-Wentworth Ambulance Service abruptly shut down because of financial problems, leaving two Grafton County towns scrambling to fill the gap. Two months before that, Berlin EMS shut down, forcing that city’s fire department to take over.
The difficulties aren’t a surprise. Two years ago, the New Hampshire Ambulance Association published a report saying emergency medical services in New Hampshire, which are a haphazard mix of municipally funded and private services, are in a “state of emergency” due to staffing and financial shortfalls. That’s especially true in rural areas with fewer people to volunteer, less tax base to pay for services, and longer distances to be covered. Similar issues have cropped up in many other states.
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Dan Tuohy/NHPRIn this year alone, two ambulance services have closed in New Hampshire. For Chris Stawasz, who’s worked as a paramedic for decades, these closures reflect larger issues currently faced by ambulance services across the state. -
Douglas Porter via Flickr CCA proposal in the Legislature would prevent insurance companies from charging customers beyond their policy coinsurance and deductions for ambulance services.
New Hampshire ambulance service providers say they’ve been stuck between outdated reimbursement rates and rising costs, which led to the surprise patient bills and a push for an increase in private insurance reimbursement rates. During negotiations, critics argued the new rate was too generous, pointing to a study commissioned by the Insurance Department that set it at 202%.
Even with the changes, the new law acknowledges that it hasn’t solved the issue. It tells the state Insurance Department to perform an actuarial cost study to decide whether the rate should change, taking into account inflation and market factors, and then issue guidance in two years.
Overall, the changes are designed to ensure that patients won’t be stuck with a full bill for transport, which can run into thousands of dollars, if an emergency requires a trip by an ambulance service not covered by a patient’s private insurance.
Other issues remain contentious. That includes what is known as “treat no transport,” in which an EMT or paramedic helps a patient at the scene so they don’t need to be taken to a facility. Such service is usually not charged.
Patients can face charges for the opposite situation, in which an ambulance service takes a person from one facility to another without treating them — something that is increasingly common in rural areas as facilities shut.
Ambulances have long been left out of debates about paying for health care even as the amount of treatment provided inside the vehicle has increased. For example, ambulances are not covered by a recent state law that aligns with the federal No Surprises Act to reduce the chance of unanticipated medical bills.
New Hampshire is served by a mix of private ambulance companies that contract with towns and cities, of which AMR is by far the largest, and companies owned by the community, often combined with the fire department. A few multi-town emergency services also exist, such as Tilton-Northfield Fire & EMS.
Chris Stawasz, a director at AMR and a member of the board of the New Hampshire Ambulance Association, told NHPR recently that the state might need to look at encouraging more multi-town services, possibly even at the county level, to spread out cost and risk.