NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A250A
SPONSOR: Magnarelli PURPOSE:
To ensure that responding ambulance service companies receive direct
payment for all emergency ambulance service transports upon submission
of an invoice to the insurance company without the need for the respond-
ing ambulance company to be a preferred provider.
SUMMARY OF PROVISIONS:
Section 1 amends section 3224-a of the insurance law to provide that
payments made to nonparticipating or non-preferred providers of ambu-
lance services made by health insurers shall be done so directly to the
provider or jointly to both the provider and the insured.
Section 2 amends subparagraphs (c) and (d) of paragraph 24 of subsection
(i) of section 3216 of the insurance law stating that the insurers shall
send such payments directly to the provider of such ambulance services
if the ambulance service includes an executed assignment of benefits
form with the claim and the provisions of this paragraph shall apply to
transfers of patients between hospitals or health care facilities.
Section 3 amends subparagraphs (c) and (d) of paragraph 15 of subsection
(1) of section 3221 of the insurance law stating that the insurers shall
send such payments directly to the provider' of such ambulance services
if the ambulance service includes an executed assignment of benefits
form with the claim and the provisions of this paragraph shall apply to
transfers of patients between hospitals or health care facilities.
Section 4 amends paragraphs 3 and 4 of subsection (aa) of section 4303
of the insurance law stating that the insurers shall send such payments
directly to the provider of such ambulance services if the ambulance
service includes an executed assignment of benefits form with the claim
and the provisions of this paragraph shall apply to transfers of
patients between hospitals or health care facilities.
Section 5. Effective Date.
JUSTIFICATION:
The constant and quick availability of ambulance response is something
that all of our citizens have grown accustomed to and it is essential to
the survivability of all New Yorkers when there is a medical crisis.
Fair and direct reimbursement for those services is paramount to the
financial stability and continued availability of ambulances to respond.
Current law permits insurance companies to pay for ambulance. service
charges direct to the patient until and unless the ambulance company
becomes a preferred provider of that specific insurance company. It is
not practical to expect a preferred provider relationship with every
insurance company. But then it is the responsibility of the ambulance
company to try to recoup payment for service from that patient.
All types of EMS providers routinely are not paid by the patient for
ambulance services even though the patient receives payment from the
insurance company. Especially as the financial crisis we are currently
facing deepens, more and more patients are pocketing these funds.
Further, the insurance company is not obligated to advise the ambulance
company that they in fact paid the ambulance transport bill direct to
the patient. This disconnect of information leads to confusion and
furthers the lack of proper payment issue.
In New York State, ambulance companies are mandated responders. As such,
most ambulance providers have no knowledge of the patient's ability to
pay or if or by whom they are insured by when a medical emergency.or
accidental event occurs. Ambulance service is one of the few medical
services where payment is not expected at the time of service.
This legislation will assure that responding ambulance service will
receive direct payment for all ambulance service transports upon
submission of an invoice to the insurance company without the need for
the responding ambulance company to be a preferred provider.
LEGISLATIVE HISTORY:
A.1309 of 2021-2022 A.6211-B of 2019-2020;
A.343-A of 2017-2018; A.8581 of 2016;
A. 6195 of 2015;.
A.7534 of 2013-14;
A.4093-B of 2011-12;
A.10735 of 2010;
FISCAL IMPLICATIONS:
None to the State
EFFECTIVE DATE:
This act shall take effect January 1, 2025 and shall apply to health
care claims submitted for payment after such date.
