Will insurance companies support recommendation to direct pay EMS?

Investigations

2018 is coming to a close and Cumberland Goodwill EMS has hit a new record, one it does not want to celebrate.

“It is the worst loss we have ever taken. We are at $220,000 for the year,” assistant chief Nathan Harig.said.

That number reflects insurance checks that patients have pocketed instead of paying for EMS services. Right now, the law allows insurers to pay members directly when a service is out of network. 

“We have lost $184,000 alone to just patients that have Highmark health insurance, so it really is our focus to try and get them to realize the urgency,” said Harig. “We want them to support EMS services.”

Highmark Health says its first priority is its members.

“Highmark values the partnership that we have with many EMS services and recognizes the invaluable service they provide to our members. Unfortunately, many EMS agencies refuse to contract with us.  We certainly invite EMS providers to join our network, however, many choose not to do so. Because of that, you are right in that we send the payment to the member. The member then is expected to pay for the EMS service. For those providers in our network, they do get timely payment, directly from Highmark,” said Leilyn Perri, a Highmark Health spokesman.

“They are going to continue to say we have to join the network but you have to accept this lower rate which just isn’t a good deal for anyone in Pennsylvania,” said Harig. “We could all solve this problem if they just pay attention to what we are saying: that this is a crisis and it needs solved.”

A Senate commission agrees there is a fire and EMS crisis in Pennsylvania. The Senate Resolution 6 Commission recently released the SR6 report. In it, members say EMS is “woefully lacking in funding.” The report includes more than 20 recommendations to address the crisis facing both fire and EMS services. Among its recommendations: permitting direct reimbursement to EMS and fire agencies which would require legislation.

“We are very excited that the Legislature is taking this seriously,” said Harig.

abc27 reached out to Blue Cross Blue Shield, Capital Blue Cross, UPMC Health, and Geisinger Health to ask if they support the SR6 recommendation to direct-pay EMS and fire services. None of the insurers responded. 

A change in the law will take time. While EMS services across the state wait to see if the Legislature will take action, Goodwill EMS is turning to the legal system to try and recoup some of its loses.

“We’ve started pursuing action against patients who pocket these checks. We are reaching out to the district justices, district attorneys, our local law enforcement leaders,” said Harig. “It is not fair to the other patients out there that are paying their bills to see a rate rise because someone isn’t paying.”

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