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Long committee hearing on HB 758 exposes deep divide: ambulance services seek 400% of Medicare while insurers warn of premium impacts
Summary
Ambulance operators and rural advocates urged the committee to prohibit balance billing and set a 400%‑of‑Medicare commercial reimbursement floor; insurers and some insurers' trade groups warned the proposal would push premiums higher and incentivize out‑of‑network behavior. The sponsor will offer technical amendments on HSA/HDHP interactions before the next session day.
A multi‑hour hearing on House Bill 758 laid out sharply divergent perspectives on surprise bills for ground ambulance rides and potential fixes to ensure rural emergency medical services remain viable.
Ambulance providers, emergency managers and rural advocates described growing reimbursement shortfalls, arguing that commercial insurers pay too little and that patients with commercial coverage are frequently left with large “balance” bills after emergency transports. Proponents asked the committee to prohibit balance billing and to set commercial payer minimums tied to Medicare — proponents recommended 400% of the Medicare allowable to offset low Medicare and Medicaid rates and to sustain services across Montana.
Multiple operators testified with detailed financial figures: managers said they collect about 40–50% of billed charges from commercial payers on average and that two services recently failed in the state. Proponents argued the legislation would protect patients from surprise bills and stabilize ambulance finances, proposing a patient out‑of‑pocket cap (testimony cited $100) and higher commercial reimbursement (proponents’ target: 400% of the Medicare rate).
Insurers and trade associations — including Blue Cross Blue Shield of Montana, PacificSource, American Health Insurance Plans and a regional co‑op — opposed the 400% floor. They argued the proposed minimum would become the de facto market rate, discourage in‑network contracting, and materially raise premiums. A Blue Cross representative showed data they say indicate most ambulance claims are currently reimbursed between ~100–175% of Medicare and asserted the carrier paid nearly all billed charges presented by their members in the prior year. Insurers also pointed to parallel proposals (HB 56 and SJR study resolutions) to support ambulance providers through Medicaid supplemental payments and studies to inform policy.
Agency technical input flagged a potential tax consequence for members of qualified high‑deductible health plans with health savings accounts (HSAs) if the bill’s cost‑sharing rules are not carefully drafted. Officials from the Department of Administration and the state insurance commissioner supplied fiscal and technical notes and recommended a clarifying amendment.
Committee action: The sponsor and committee agreed to delay final executive action on HB 758 to permit drafting of an amendment addressing HSA/HDHP interactions and other technical language; the sponsor indicated he would work with the deputy insurance commissioner and department staff and return with amendment language the next day.
The hearing highlighted the difficulty of balancing patient protections and rural provider solvency with insurer market dynamics; members asked for more data and cross‑stakeholder work before further action.
