Now that we’ve established the common circumstances around paying for emergency medical services in blog 1 of this series, let’s take a step back and think about who should be paying the bill when you or your family has a medical emergency and receives care from an EMS crew.
You are already paying into the healthcare system. Whether you are contributing a portion of your income to Federal Medicare taxes or paying premiums on an insurance plan, you are contributing at least monthly to cover the cost future medical expenses. Where that money goes is determined by those who administrate the programs.
Medicare establishes allowable reimbursement rates for the medical expenses it covers. These rates rarely cover the actual cost of the service, but healthcare providers, including EMS are not allowed to pursue further reimbursement once Medicare has paid. Commercial insurance determines which services it will cover, at what rates, for its plan participants. You have likely experienced how different one insurance plan can be from another as you have changed jobs, or your company opted for a different insurance provider. Commercial insurance could decide to preferentially cover EMS services, understanding that in the case of an emergency, you, as the patient, have little to no time to choose who will care for you or your family member.
Because EMS services struggle to get the major governmental and commercial payers –to reimburse them at a level that actually covers the cost of responding to emergency calls in rolling intensive care units with highly trained personnel, taxpayers and others end up eating the expense. EMS crews and agencies are committed to their role as first responders. They show up, knowing, frequently that they may end up giving away their services because it is the right thing to do for people and their community.
If commercial insurance plans committed to paying for the life-saving interventions that EMS provides, at a rate that could support the care, patients could expect a significant decrease in the possibility of a surprise bill for emergencies