I like my surprises to come in small boxes wrapped with ribbon. Unfortunately for many of our patients that's not the way their surprises arrive. Surprise medical bills are getting a lot of attention in the national news.  The Brookings Institution released a study earlier this month noting that as careful as some providers are about determining whether a hospital or service is in network, there are still many patients getting hit with unexpected bills. The Brookings Institution study notes that the ambulance industry is one of the most common areas surprise medical bills come from, particularly related to emergencies. Per the new study, the amounts the patients are expected to pay are often 10 to 20 times more than what they anticipated.

The issue I want to bring to your attention is what's going on in places like California where a new law was recently enacted to prohibit balance billing for medical services. The new law, Assembly Bill 72, “the Act authorizes an insurance company to limit what physicians who are outside of its network (“out-of-network” or “noncontracting”) may charge.” The idea is to remove patients from being caught in the middle between insurers and providers who do not contract with those providers. The bill in California prohibits the balance billing the patients.

Folks, the ambulance industry needs to tune into what's going on here. Typically, emergency providers do not contract with payers; thus, emergency ambulances are out of network. When a provider is out of network they are often paid at a lower or non-network rate. As a result, balance bills are sent to patients and the provider needs to chase the patient for those amounts. That's a very tough challenge when there are so many other medical bills coming at your patients.

So, providers face a cash flow problem. But the issue I'm talking about is not private pay. Think about that for minute - what would you do if you couldn't balance bill and try to collect the amount of your charges?  There is pushback going on California; a group of doctors have filed suit to protest this new law but the concept of eliminating surprise medical bills has gotten traction.

I know that there are pros and cons to contracting. Perhaps we are coming to a new age where how we contract and balance-bill will change. Regardless of what the future holds, we need to stay tuned to this topic.

Let us know if we can help!

About the author:  Maggie Adams is the president of EMS Financial Services, with over 20 years’ experience in the ambulance industry as a business owner and reimbursement and compliance consultant. Known for a practical approach and winning presentation style, Maggie has worked with medical transportation providers and billing companies of all kinds to support their billing, auditing, and documentation training efforts. Check out our newest documentation training webinars and billing webinars on our website.Friend EMS Financial on Facebook, or for more info, contact Maggie directly at maggie@ems-financial.com or visit www.ems-financial.com