The state laws are facing that sudden bills will stop a review from insurance companies: shots

Nicole Silva’s 4 -year -old daughter was heading to a relative’s house near the southern town of La Jara in Colorado when a vehicle united her by the car she was wandering. This was followed by a series of ambulances-a ground ambulance to a local hospital, an air ambulance to Denver, and another ground ambulance for the Children’s Hospital.

Silva’s daughter was on Medicaid, who was supposed to cover the cost of ambulances. But one of the three ambulance companies, Northglenn Ambulance, a public company since then I gained it for one specialSend the Silva bill to the debt mosque. The court records were $ 2,181.60, which grew to more than $ 3,000 with court fees and benefits.

The pre -school teacher was unable to pay, and a mosque was wage. “We have put in the bills on bills – home batches, electricity, phone bills, and food for children,” said Silva, whose daughter has fully stumbled from the 2015 accident. “It took it out of everything.”

Some legislators in the states are looking to reduce bills such as the heads they received – sudden draft laws for ground ambulance riding.

When the ambulance company receives more than that the insurance company is ready to pay, patients can be left with a big bill that they may not have had a choice.

Countries are trying to fill a federal gap There is no surprise workThat covers air ambulances but not ground services, including ambulances that are transmitted by road and water. This year, Utah and Northern Dakota joined 18 other countries That has gone through the protection against sudden bills for such tours.

This protection often includes determining the minimum insurance companies for payment if someone covers him needs a trip. But the thorny point is the place to appoint this tape. The legislation in Colorado and Montana has stopped this year because policymakers are concerned that forcing insurance companies to pay more would lead to high costs of health coverage for all.

Surprising ambulance bills are one part of the health care system that systematically grieves Americans with medical debts, stresses their financial resources, preventing them from accessing care and increasing ethnic discretion, as reported by KFFHELTH News.

“If people hesitate to call the ambulance because they are concerned about putting a huge financial burden on their families, this means that we will get the victims of the stroke who do not reach the hospital on time,” he said. Patricia KilmarWhich directs PIRG health care campaigns, a national consumer invitation group. “This means that the person who is concerned that he may be a heart attack will not call.”

Challenges to pass the protection in Colorado

The Law of Surprises, which President Donald Trump signed in 2020, says that for most emergency services, patients can be prescribed to obtain care outside the network only for the same amount that could have been described if it was in the network. Like doctors or hospitals, ambulance companies can contract with insurance companies, making them in the network. Those who do not remain outside the network.

But unlike setting an appointment with a doctor or planning for a surgery, the patient cannot generally choose the ambulance company that will respond to the 911 call. This means that they can develop large bills outside the network.

Federal lawmakers included inserting the ground ambulances, partly due to a variety of business models – from private companies to volunteer fire departments – and the lack of data about the cost of horseback riding.

Instead, he created Congress Consulting Committee Which issued recommendations last year. Her comprehensive conclusion – that patients should not be stuck in fire between service providers and motivations – was not controversial or party. In Colorado, gauge It aims to expand the scope of protection from sudden bills, which has been unanimous in both legislative rooms.

Colorado was previously Law passed Protect people from sudden bills from private ambulance companies. This new procedure was aimed at providing similar protection against bills from public ambulance services and lights between hospitals.

One of them said: “We knew that he had support from the two parties, but there are some people who vote for everything.” Karen McCromicA representative of a democratic state.

A less pleasant surprise came at a later time, when state governor Jared Police, who is also a democratic, interfered with him, citing the fear of high installments.

The states can not do a lot except in this matter, because state laws apply only to the state’s health plans. This leaves a lot of workers. According to 2024 National Survey Written by KFF, a non -profit health information that includes KFF Health News, 63 % of people who work for private employers and get health insurance through their jobs Self -funded plansWhich is not organized for the state.

“This is why we need a federal ambulance protection law, even if we pass 50 state laws,” Kilmar said.

According to the statements of the Foreign Minister of Colorado, the only pressure groups Registered as “opposition” The draft law was Antem and UNITEDHELHELTH GROUP, as well as the companies affiliated with UNITEDHELHELHELTHEMMHEMHELTHCARE.

Once the legislative session ended in May, Kevin McFridgeCEO of the Colorado Health Plans Association, a commercial group representing the health insurance companies in the state, A message to the ruler Requesting the veto, with an estimate that the legislation will lead to 0.4 % increase in installments.

The Colorado Bill said that local governments – such as cities, provinces or private regions – will put prices.

“We are in a much better place by the lack of local entities in their own price mode,” McFaftaidge told KFF Health News. “This is almost similar to the Fox Hem management.”

Resistance from the insurance industry

Jack HoodleyA honorary research professor at McCart College for Public Policy at Georgetown University said that it is not clear whether the laws of the states that were approved elsewhere are provoking installments, or if so. Hodley said Washington is expected to issue an effect of its law within two years.

The National Trade Association for Insurance Companies, AHIP, rejected a comment for this article. Instead, AHIP has redirect the messages that its leaders submitted to the legislators In Ohioand Virginia WesternAnd Northern Dakota This year, to oppose measures in each state to put the basic ambulance rates. The AHIP leadership described the proposals as the amplifying pricing imposed by the government that would reduce the opportunity of insurance companies to negotiate fair prices. In the end, the association warned that the minimum proposed will increase health care costs.

In Montana, legislators They were thinking The minimum payment of 400 % ambulance cars, which is paid by medicare, or at a specific local price in the case of one. The proposal was sponsored by two Republicans and supported by ambulance companies. Health insurance companies succeeded in pressure against them, on the pretext that the price was very sharp.

Sarah Clairegit, pressure groups representing AHIP, legislators in Montana in a legislative hearing that it is already difficult to make ambulance companies in the network with insurance companies, “because people will need ambulance care regardless of whether their insurance company will cover them.” She said that the state’s proposal will leave those who pay the price of health coverage with a new price burden.

“None of us loves our insurance rates to move,” Republican Senator. Mark Noland He said during a legislative meeting every committee that submitted the draft law. He equated the minimum proposed delegation, which may have to push people to pay more for health coverage for important service, but however.

The Colorado Governor is the same on insurance premiums. Police said in it Cassation message The legislation would have raised premiums between 73 cents and $ 2.15 per member of the month.

“I agree that filling this gap in enforcement is crucial to providing money for health care,” he wrote. “However, these cost savings excel in my opinion through strong increases.”

Isabel CruzThe director of politics at the Consumer Health Initiative in Colorado, who supported the draft law, said that even if the installments have risen, colorradans may be fine with change. After all, she said they would trade a large ambulance bill at a price of half a cup of coffee monthly.

KFF Health News It is a national news room that produces an in -depth press on health issues and is one of the basic operating programs in KFF.