Struggling Ambulance Services Want Help From Harrisburg

PITTSBURGH (KDKA) -- Emily Wheeler of Valley Ambulance Service is a paramedic in perpetual motion, rushing to as many as a dozen calls a day.

On Thursday, she and her partner arrived on the scene of a woman is suffering a seizure, a situation demanding an emergency response whether the patient has insurance or has any ability to pay.

"Everybody we see is having a bad day, and everyone is someone's mother, father, brother, aunt, uncles. We can't pick and choose," says Melvin Musulin, the assistant director of Valley Ambulance Authority.

Ambulance services throughout the region are in financial trouble. Some have gone out of business and others are struggling to get by. Sooner or later, they say patients' lives will hang in the balance.

"If you have to reduce crew in the evening or during the day; obviously, there's going to be a longer response time," said Musulin

The average call costs about $600 and Medicaid pays only $200 of that. Currently, the ambulance services are at odds with private insurance companies, many of whom insist on reimbursing the patient instead of the service.

"Often time the patient will spend that money rather than turn it over to the ambulance service," says J.R. Henry, the director of Valley Ambulance Authority.

KDKA's Andy Sheehan: "So you become like a collection agency?"

Henry: "Right."

Last year, patients pocketed about $200,000 owed to Valley, and their case is typical. To remedy that, they'd like the insurance companies to pay them directly.

State Sen. Don White, the head of the Senate Insurance Committee, says he has a bill to do just that.

"My bill would make it law. The insurance companies would pay directly to the service companies, the EMS service," he says.

But Sen. White is no hero to the ambulance service. They don't support his bill, which would give them direct pay, but they say would require them to take lower rates from the insurance companies.

"That is not satisfactory to us," says Henry. "What we're trying to do is save people's lives and what we need is not reduced revenue, but enhance revenue in order to save people's lives."

The debate goes round and round.

Sen. White, a former insurance agent who has received large contribution from insurance companies, says the ambulance services need to negotiate those rate directly with the insurance companies.

He also says he does not support so-called balanced billing, ambulance services billing patients to make up the difference.

"I say let's get this direct pay. It's been vetted, it makes sense, and then we'll work on this balance billing issue," Sen. White says.

In the meantime, Valley will continue to lose money on calls.

Valley paramedics respond to 8,000 transports every year, and for many of these transports, they don't get paid. How much longer that can go on remains an open question.

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