Should Montgomery County voters not be asked to weigh in on an ambulance fee again this November, a program to bill insurance companies for reimbursement of ambulance rides will start Jan. 1, 2013.
A similar measure narrowly passed the council in 2010 with a 5-4 vote, only to be later repealed by voters in the November election that year.
Unlike its predecessor, the bill passed Tuesday — which overturns the voters’ decision — includes language and provisions crafted by the council to avoid the confusion and misinformation that some allege surrounded the hard-fought campaigns for and against the bill.
Who would pay under the legislation received much council attention, as the board worked to ensure it was clear county residents would not pay a dime. The council amended the bill to clearly state residents “must not be required to pay any out-of-pocket expense” relating to an ambulance ride. Only insurance companies and patients who live outside the county would pay under the law.
Of the transports made annually, an estimated 20 to 30 percent are for patients who are not county residents, said Eric Bernard, executive director of the Montgomery County Volunteer Fire Rescue Association — which opposes the bill.
Cost-sharing of EMS transport fees is common among health insurers, said Susan Pisano, spokesperson for America's Health Insurance Plans, a trade association representing the health insurance industry.
Most states require the insurance companies cover EMS transport, but do not preclude the company from requiring the patient to share in the cost of the ride, Pisano said.
Medicare covers 80 percent of its fee for transport, which can vary from what is charged by an ambulance company, requiring patients to pay 20 percent of the cost, said Ellen Griffith, spokesperson for the Centers for Medicare and Medicaid Services. It also has strict standards of necessity and reasonableness which much be met for Medicare to reimburse for the service.
Property and liability policies vary widely when it comes to what is covered for ambulance transport, said Jim Whittle, assistant general counsel and chief claims counsel of the American Insurance Association, a trade association for property and casualty insurance companies.
A resident of Montgomery County, Whittle said he knows residents already pay significant local taxes and is concerned such a policy would be tantamount to double taxation. Across the country, he said, fees for EMS transport are the exception, not the norm.
Because Montgomery County would be the entity responsible for billing for any portion of the ambulance transport not covered by a patient's insurance, it can guarantee no resident pays, county spokesman Patrick Lacefield said.
"For county residents we will accept whatever an insurance company pays for that service," he said. "Some [insurance companies] might pay full, some might pay half, some might pay only $50. We will accept that and we will waive the rest for the county resident and the reason we will waive that is you already pay county taxes."
In its language, the bill assumes that residents of the county already have paid any uninsured portion of their transport through the taxes they pay to the county.
Bernard said his association is considering all options, including accepting the council’s decision and possibly putting the issue before the voters again in November.
Once fully implemented, County Executive Isiah Leggett (D) has said he expects it would raise as much as $18 million annually.