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Troy authorizes updated ambulance billing amounts; council seeks clarity on who bears unpaid balances
Summary
Council authorized the fire chief to submit a 2025 rate-change form for Comstar LLC to increase the ambulance cash-billed amounts; discussion centered on whether increased billed amounts affect insured patients and how collections and hardship provisions apply to residents with unpaid balances.
The Troy City Council finance committee on Jan. 23 approved a resolution authorizing the fire chief to complete a 2025 rate-change form for Comstar LLC, the city's ambulance-billing vendor, to raise billed ambulance amounts.
During discussion councilmembers and staff clarified the measure does not increase the fees the city pays Comstar for billing services; rather, it increases the amounts that are billed for ambulance services (the cash price). City staff explained Comstar compared Troy to its ‘‘top 50’’ providers nationwide to set average billing rates; councilmembers asked whether those comparators are local and were told many are out of the Massachusetts area and not all are local.
Members raised concerns about what happens when an insurer pays less than the billed amount. Staff said Comstar follows the city's direction on collections, that hardship provisions are available, and that Comstar does attempt to recoup unpaid balances in some circumstances but will not pursue extreme measures unless directed. The council also discussed differences between billed, allowable and negotiated insurance rates and the interaction with Medicare and other payers.
Council asked the fire chief for specifics about service levels (basic life support vs. advanced life support) and the share of calls that fall in the higher ALS2 category; staff estimated ALS2 calls represent a small percentage (roughly 2% cited offhand) of total calls. After questions and clarification the resolution was moved and adopted unanimously.
Next steps: the chief will file the rate-change form with Comstar and the city will continue to monitor the effect of the higher billed amounts on collections and resident hardship cases.
