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Committee hears emotional testimony on HB 758 as ambulance providers and insurers clash over reimbursement floor
Summary
HB 758, which would limit patient out‑of‑pocket ambulance balances and set a commercial reimbursement floor tied to Medicare, prompted lengthy testimony from ambulance operators asking for 400% of Medicare and insurers warning of premium increases and unintended market distortions.
The Senate Business, Labor, and Economic Affairs Committee on Tuesday heard hours of testimony on House Bill 758, a proposal to prohibit balance billing for ground ambulance transports and set a commercial reimbursement minimum tied to the Medicare allowable. Proponents argued the bill protects patients from surprise bills and would stabilize rural ambulance services; insurers warned that an imposed 400% Medicare floor would raise premiums, encourage out‑of‑network billing, and may be premature while other funding solutions progress.
Don Whalen, manager of Missoula Emergency Services and president of the Montana Ambulance Association, urged the committee to act to spare patients from surprise bills and keep ambulances staffed and ready. “We are just gonna show up,” Whalen said, arguing that patients calling 911 should not later incur large balances because insurers pay a low share of billed charges.
Ambulance operators described low public reimbursements from Medicare and Medicaid and said private insurers increasingly pay less of billed charges. Tim Brester, an ambulance owner and paramedic, testified HB 758 would cap patient out‑of‑pocket ambulance costs at $100 and sought a reimbursement standard of 400% of the Medicare allowable to make providers financially viable in Montana’s low‑reimbursement environment.
Insurers, including Blue Cross and Blue Shield of Montana and PacificSource, opposed a flat 400% floor. Drew Chuck of Blue Cross told the committee that raising the minimum to 400% of Medicare would effectively become the new floor, removing incentives to contract with plans and increasing premiums. “This new minimum would almost double their rates,” he said, citing insurer analyses of current reimbursement ranges. Blue Cross also urged the committee to allow time for related bills (including HB 56, a Medicaid supplemental payment proposal) and a study resolution (SJR 13) to work.
State officials provided technical context: Amy Jenks from the Department of Administration explained the state plan fiscal note, and Deputy Insurance Commissioner Frank Cote warned the committee that absent an HSA‑preserving amendment the bill could create tax consequences for people in qualified high deductible health plans; Cote recommended language to avoid inadvertent IRS/HSA qualification issues.
Representative Gist, sponsor of HB 758, said the committee had heard both sides and was open to drafting technical amendments; he postponed executive action on HB 758 until an amendment could be prepared and agreed the HSA language will be considered.
Provenance Topic introduced: SEG 2369–2376 (sponsor opens HB 758). Top finish: SEG 3892–3898 (committee concluded hearing and deferred for amendment).
