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Sha'Ron James


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EMT Working Group Takes A 'Balance' Approach

 

Date: October 21, 2016
Source: WFSU
Author:  Jim Ash

 

Anthony Sangenito doesn’t remember the 21-mile air ambulance ride he took last summer because he wasn’t conscious. But debt collectors aren’t letting the 46-year-old property manager forget it.

They call Sangentio’s cell at least once a week demanding 25 thousand dollars.

““It’s like they’re trying to do something under the guise of them being wonderful people, and then you get a bill that just makes you shake your head. How could a company do that?”

Sangenito’s ordeal began last summer when he felt a sudden pain in his stomach and had a friend drive him to South Lake Hospital. During emergency surgery for a perforated intestine, Sangentio went into convulsions and had to be airlifted to Orlando Regional Medical Center.

He didn’t realize he had been to ORMC until he came out of anesthesia.

“It was hours later, in an ambulance, transporting me back to South Lake Hospital.”

Sangenito’s United Health Care insurance covered most of the bills, but Air Methods, the company that flew him, was out of network. United Health paid part of the 39 thousand-dollar flight, but Sangentio was stuck with the rest. The practice is called “balance billing.”

Consumer advocates are heralding a new Florida law that bans most balance billing. But legislators left ambulance services out of the legislation, largely because local governments play such a big role.

Insurance Consumer Advocate Sha'Ron James says it’s too early to say whether the group will recommend expanding a balance billing ban to cover ambulances.

“The goal at this point of the working group is fact finding, data collecting, just understanding the issue.”

Air and ground ambulance providers say it’s expensive to keep equipment and professionals on 24-hour standby. Air Methods, the company that flew Sangenito, just closed a base in Gadsden County near Tallahassee. Company officials say they couldn’t afford the 3 million-dollar annual cost.

Industry spokeswoman Amanda Thayer says Medicare and Medicaid pay just a tiny fraction of the cost, yet they cover most of the people who end up in an air ambulance.

“Seven out of ten transports of the service are patients who have Medicare or Medicaid or are uninsured.”

As a result, Thayer says, providers either have to close shop or shift costs to privately insured patients like Sangenito.

Deputy Chief of Leon County EMS Mac Kemp isn’t calling it a crisis, but he says local officials are trying to decide how to attract another provider.

Kemp is a member of the working group and he says providers need to be able to bill patients.

“I can’t say that balance billing is the only solution. But right now, today, EMS systems across Florida need balance billing in order to survive.”

Florida Fire Chief’s Association President Dan Azzeriti, another member of the working group, agrees. And he says insurance companies need to pick up more of the load.

“Fire departments are doing this for 25 cents on a dollar. We have nothing else we can give, there’s nothing else they can do. And if insurance providers do not want to pay more, that’s where the problem lies.”

Wences Troncoso, vice president of the Florida Association of Health Plans, also sits on the working group. And he brings the argument full circle. He says ambulance services are charging unreasonable rates and shouldn’t be allowed to balance bill patients.

“We believe this is the only way to put in place a check upon a non-competitive market place that has led to an unreasonable and unconscionable balance billing against consumers.”

But some experts predict that will be difficult. They say air ambulance providers are protected by the 1970s era federal airline deregulation.