In parts of Massachusetts there is a little bit of a war going on. No, it’s not the Continental Army fighting the redcoats, but there is a war going on right now. It’s between Blue Cross Blue Shield of Massachusetts organization and the local EMS organization that’s providing care. It has to do with what the ambulance services are calling “strong-armed tactics” to force ambulance services to become participating providers in the insurer’s network.
Encouraging Insurance Fraud
The insurance companies are doing this by paying their patients directly so an insurance company instead of paying the actual EMS service when they submit a bill. They’re paying the patients and the patients are supposed to go ahead and reimburse the EMS service. I know we’ve seen this in our area in Maryland. What has happened is we know these patients have been paid but we’ll never see a dime of it. They just cash the check and never forward any of it on to the ambulance company.
This is happening in Massachusetts as well. This article says the insurance companies are basically encouraging fraud, encouraging these people run off with the money that does not belong to them. This practice isn’t a cost savings measure for the insurance companies, it costs them the same amount to send a check to either source, but by putting pressure on EMS to become a participating provider for even less reimbursement, they create a situation where EMS is forced to cut back services.
Reducing EMS Coverage Area
American Medical Response (AMR) is a very large in and prosperous ambulance company in the United States that provides not only interfacility transport services in different areas but also contracts with municipalities and local jurisdictions to provide 911 based EMS services. The New England general manager for AMR is saying that this practice from insurance companies is putting them out of business in certain communities. These communities are going to lose their ambulance services as a result because it’s just no longer profitable to provide service in them.
If the patients will not pay and will not forward the money they’re getting from the insurance company on to the ambulance service then the ambulance services have no choice but to drop out of covering a given area. We just can’t keep going and doing this for free, especially when it’s a for-profit company that’s out there under contract with local jurisdiction. They just aren’t going to be able to work in that jurisdiction anymore.
Changing the Way EMS Bills
Some states have enacted laws that say that if you’ve if you are paid by your insurance company for medical service and fail to forward that money on that you can be charged with insurance fraud. Basically, you filed for an insurance claim and then kept the money. Unfortunately for AMR in Massachusetts this isn’t the case at this time and it’s forcing them to reduce coverage area for EMS service in certain parts of the state.
Follow up on the links for this news item and the additional resources in this episode’s shownotes — Lidocaine EMS Review and Episode 302.