A bill headed for Gov. Kathy Hochul's desk would change the pay model of New York ambulance providers, as emergency service agencies have grappled with deep financial issues and staffing shortages for years. But insurance companies are fighting hard for the governor to veto the measure.
The Legislature unanimously passed the legislation, nicknamed the direct pay bill, for the first time this session, requiring health insurance plans to immediately reimburse ambulance providers when they transport a patient with coverage outside their network.
Ambulance services in the state treat and transport anyone, regardless of insurance or ability to pay, but when the provider isn't a member of the patient's insurance network, the patient is paid directly instead of the ambulance agency.
"That has been something that's problematic for ambulance services, because then it is up to us to collect from the patient," said Steven Kroll, a board member of the state Volunteer Ambulance and Rescue Association. "And sometimes, the patients don't want to pay us, or don't remember to pay us and we find ourselves chasing the payment for the services that we have rendered."
Kroll, the chief of Delmar-Bethlehem EMS in Albany County, said it's long contributed to financial hardships as ambulance prices have increased between 30 and 40% in the last several years.
"Inflation hits us on everything we buy, just like it hits everybody else's pocketbook," Kroll said Tuesday.
Advocates for and against the change are working to influence Hochul's decision to sign it.
Emergency service workers have sent the governor letters in the last few days, saying it would give ambulance services the financial sustainability to maintain equipment and increase wages for EMTs, who typically earn close to minimum wage.
"We're trying to make this a profession that can be sustainable as a career. We have to raise the money to do that," Kroll said.
Insurance companies, meanwhile, are pushing Hochul to veto the bill.
They argue it would allow ambulance companies to charge whatever they wanted for services, reducing quality of care.
Lev Ginsburg, executive director of the state conference of Blue Cross & Blue Sheild plans, says the automatic direct payment will remove insurance companies' incentives for ambulance providers to join their network, leading to higher costs.
"This is a very much an anti-consumer bill," he said. "What the bill really does, in essence, is it undermines the networks that plan to put together to protect their enrollees and to keep costs down. It does nothing to enhance the quality of care. It does nothing to enhance the services that folks are getting, it simply serves to make more money for ambulance companies."
In addition to letters, stakeholders on each side of the argument alike have spoken with members of Hochul's staff to persuade the governor to sign or veto the legislation. They have not received a response about her intent to support, or if she's likely to take issues with the proposal.
Ginsburg said Tuesday if signed into law, the measure would undermine insurance networks and negatively impact consumers.
"What this bill ultimately does is, it removes that incentive for the quality service at a negotiated price and just allows ambulances to charge anything they want," he said.
But sponsor Assemblyman Bill Magnarelli says ambulance providers weren't getting paid for their services, and their pay model must be changed.
Otherwise, the lifesaving services could disappear across the state.
"That's the problem we were trying to take care of — and it really involves the insurance companies," Magnarelli said. "They've been able to kind of circumvent things, which I don't really understand, because they were still paying out money, but it wasn't going to where it should go."
Lawmakers changed bill language before voting to pass it to require providers charge insurance companies a "reasonable" market rate.
But at the end of the day, the assemblyman says the debate doesn't have a price tag.
"The cost is human cost," Magnarelli said. "People are going to die — just say it. That's what's going to happen if you don't get an ambulance on time. If you stop having EMS out in different parts of the state where it takes an inordinate amount of time to get to a physician or a hospital, people will suffer. That's what's going to happen. Forget the money. That's what's going to happen."