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Kudos to the San Antonio City Manager for proposing increases to the ambulance fees charged by the fire department.
It’s generally good public policy to reduce tax burden for ambulance service by charging a market rate for those services. Under-billing (referred to recently by a Texas Medicaid official as a ‘nominal fee’) essentially uses tax dollars to subsidize commercial insurers.
Medicare and Medicaid reimburse ambulance agencies at a fixed fee schedule, and patients are not balance billed. Self-pay patients generally don’t pay. Commercial insurers typically reimburse 80% of what they determine to be the usual and customary rate, or 80% of billed charges.
Charging an appropriate market rate helps assure the commercial insurers are reimbursing at a reasonable rate.
Also, many states are proposing GEMT programs that are not cost-based, but instead based on the difference between what Medicaid reimburses and the average commercial reimbursement.
Departments that do ‘nominal’ billing (billing far below the market rate) are penalizing taxpayers (by not maximizing insurance reimbursement), and each other (by lowering the average commercial reimbursement calculation).
It’s reasonable public policy to charge fees that maximize commercial reimbursement and implement charity care policies for patients without health insurance.
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San Antonians could soon pay more for ambulance transport. Here's why.
The proposed rate increase for ambulance rides in San Antonio would go from $1,000 to $1,500 in two years.
Author: Meredith Haas
August 16, 2024
https://www.kens5.com/article/news/politics/san-antonio-proposes-rate-increase-ems-transports-kens5/273-27125857-608f-402d-b620-6ee28cc123cd
SAN ANTONIO — The City of San Antonio is considering upping the price of ambulance rides by hundreds of dollars.
There hasn’t been an increase in this medical cost since 2019, but one City Council member is speaking out against the proposal. In a Thursday meeting, City Manager Erik Walsh recommended raising the current EMS transport fee from $1,000 to $1,500 in the next two years, as part of a budget proposal presentation.
Walsh said their plan is to raise the cost by $250 in Fiscal Year 2025 and another $250 the year after. The expectation is to generate $2.6 million in FY 2025, which begins Oct. 1 and runs through Sept. 30 of next year.
They expect 69% of the costs to be covered by insurance and 25% by Medicaid. But not everyone thinks this is a good way to bring in revenue for the city.
"We need to keep it at a thousand dollars… we call it a charity fund, but it really is an equity fund," District 3 Councilwoman Phyllis Viagran said.
Uninsured residents have the chance to waive their bill through a charity fund created by council members three years ago, but Viagran wants to do more.
She said the constituents in her district are already running low on hospital beds.
"So if there are no more beds… they’re transferred a second time.”
That can be costly. And if the cost of transport goes up, Viagran said, that just adds to the burden.
The Center for Health Equity in South Texas will try to advance community members' health and create better outcomes.
“That’s why I'm supportive of the center of health equity taking a look at that [rate increase]."
Viagran said she is hopeful to look at different ways to find the $2.6 million.
