During a recent government meeting, discussions centered on the complexities of billing practices for emergency medical services (EMS) and the implications for patients covered by various insurance plans, including Medicaid, Blue Cross, and Medicare.

A representative detailed the financial dynamics of ambulance services, highlighting that a typical ALS emergency response incurs a gross charge of approximately $1,200. However, reimbursement varies significantly based on the patient's insurance. For Medicaid patients, the service provider receives only $180, with the remaining balance written off as a contractual adjustment. In contrast, Blue Cross covers $450 of the charge, but patients may still face additional costs due to outstanding deductibles. For instance, if a patient has a $200 deductible, they would receive a bill for that amount despite the insurance coverage.

The representative emphasized that billing practices are dictated by insurance contracts, which often leave patients surprised by unexpected out-of-pocket expenses. This situation is particularly pronounced for Medicare Advantage patients, who may encounter inconsistent coverage and co-pays that can change throughout the year.

The meeting also touched on the issue of surprise billing, which the ambulance association is actively addressing alongside hospital associations and other EMS stakeholders. The representative noted that surprise billing often stems from patients being unaware of their insurance coverage limitations, particularly when high deductibles are involved. As contracted providers, EMS services are bound to bill patients for these amounts, and waiving such charges requires notifying the insurance provider, complicating the process further.

In addition to the billing discussions, the meeting confirmed that the EMT Academy continues to operate at its location on Gratiot Avenue in Clinton Township, now situated at Gratiot and Metro Parkway. This highlights ongoing efforts to train and prepare future EMS professionals in the region.