Law lacks clarity on insurance

AMED and other ambulance services across Pennsylvania are in the proverbial dark — and rightly concerned — about how much they ultimately will benefit from a new law dealing with reimbursements for situations in which transportation to a hospital isn’t needed.

About all that can be deemed assured at this time is that any money the services receive as a result of the new measure will benefit them in regard to their ongoing operations.

What’s important, looking forward, is that the state ensures that still-to-be-published regulations connected to the law address the current uncertainties and concerns as completely as possible.

The law was written and passed with good intentions; it’s important that those intentions not be short-circuited, despite some limitations state lawmakers recognized as they were crafting the bill.

Here’s the scenario:

There are instances when ambulance crews are summoned, such as to accidents and medical-related situations, where the treatment they provide at the scene is sufficient.

Examples are when they provide a dressing for a small cut or, as an article in the Nov. 26 Mirror related, “to bring someone out of a diabetic attack.”

According to last month’s article, the new law requires payment to ambulance services for treatment rendered without transport. However, it remains unclear whether that will mean full payment of charges or only some portion of the total cost.

In the Nov. 26 article, Gary Watters, AMED executive director, was quoted as saying that he didn’t know how the new law would affect the local medical emergency service financially, but predicted AMED would not experience a revenue windfall.

Whether or not such a result plays out, there’s at least one major concern. According to Watters, it’s whether insurance companies will comply with this new obligation.

Some people might respond that a law must be obeyed, but a valid question is whether new limitations legally could or would be written into insurance policies to circumvent what the law stipulates.

Then there are the other limitations that lawmakers acknowledged when considering whether to pass the new law, one of those being that the law won’t have any effect on the federal government’s policy, under Medicare and Medicaid, not to pay for treatment by an ambulance crew without the patient having also been transported to a hospital.

According to Watters, a major regulatory uncertainty surrounding the new law revolves around the question of “what defines treatment.”

But Watters made the good point that the law — at least theoretically — removes the incentive for ambulance services to transport patients unnecessarily to an emergency department, with the goal being to receive payment for their services.

It can be said that the law will benefit insurance companies, by relieving the burden for them to pay for high-cost emergency department services that aren’t really necessary.

The bottom line is that, in order to survive and be able to provide the best possible service and care, AMED and other ambulance providers need revenue.

The new law seems poised to help meet that need and minimize instances of non-payment, if the coming regulations are successful in addressing existing questions and concerns.