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Insurance department backs cost‑based fee schedule and ban on ambulance balance billing after actuarial study; providers warn rates are too low
Summary
Following an actuarial review, the New Hampshire Insurance Department recommended rules to set a cost‑based fee schedule for out‑of‑network ground ambulance reimbursement, prohibit balance billing of patients and form a commission to explore an all‑payer waiver. The proposal divides providers and payers and drew extensive public testimony.
Representative Tom Hunt introduced House Bill 3316 after the Insurance Department completed an actuarial study and a stakeholder summit. The department urged the committee to adopt a cost‑based, annually updated reimbursement schedule for out‑of‑network ground ambulance services, prohibit balance billing of consumers and create a commission to study an all‑payer model under a federal 1115 waiver.
Why it matters: Ground ambulance providers across New Hampshire report rising operational stress. The department and its vendor, PCG, concluded commercial payers currently reimburse near Medicare levels while providers’ cost structures require materially higher payments to close a funding gap. The committee heard competing claims about how large that gap is and whether the PCG schedule would be sufficient to maintain services.
Insurance Department proposal and PCG study Insurance Commissioner D.J. Bettencourt described a multi‑stakeholder ‘‘ambulance summit’’ and said the…
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