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Senate of Pennsylvania
Session of 2023 - 2024 Regular Session


Posted: January 27, 2023 02:05 PM
From: Senator Katie J. Muth and Sen. Michele Brooks
To: All Senate members
Subject: Direct EMS Reimbursement
In the near future, we plan to introduce legislation similar to HB 1293 of the 2021-2022 legislative session. This bill would address a longstanding billing issue plaguing our emergency services providers in this Commonwealth.
Our legislation will amend Act 284 of 1921, known as the Insurance Company Law to require insurance carriers to reimburse ambulance companies for 911 emergency medical services provided regardless of whether the EMS agency is part of the insurance carrier's network.
This bill will repeal specific provisions under the act that were implemented in 2015 by Act 84, which created a "registry" to be maintained by the Department of Health, which out-network 911 ambulance companies could select annually from which insurance carrier they would be willing to receive reimbursement.
When a 911 emergency medical services agency responds to a legitimate 911 emergency call and renders emergency services to a patient covered by a health insurance policy that includes this coverage as a benefit, network membership should not be a hurdle to an ambulance company receiving due recompense for services provided.
Although the provisions contained in Act 84 were the result of a compromise, it still falls short of addressing a significant unfairness, which is not paying a business directly for providing a legitimate, valuable and verifiable service; a service an insurance carrier's very own enrollee requested in a time of need.
Please join us in cosponsoring this legislation to require insurance carriers to fairly pay ambulance companies for a legitimate service provided under a 911 emergency call even though they may not be in a network.