Bill addressing 'ambulance gap' in health insurance scheduled for state House committee hearing next week

Posted at 5:26 PM, Mar 11, 2024
and last updated 2024-03-14 08:15:41-04

DENVER — Legislation addressing the so-called "ambulance gap" in health insurance is scheduled to be heard in the state House of Representatives Health and Human Services Committee next week.

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'Ambulance gap': The surprise medical bill loophole explained

Jaclyn Allen
2:20 PM, Apr 25, 2023

HB24-1218 would allow an ambulance service to submit rates to insurance for reimbursement covering out-of-network costs.

The bill prohibits an ambulance that's out-of-network from billing a patient more than their health insurance covers, which can leave the patient to pay high amounts in medical bills for the difference. The exception to that would be the required deductibles or copayments under that person's insurance plan.

The introduction of this bill stems from the experience of Coloradans like Mary and Alvin Gordy. When Alvin had a seizure at his doctor's office in July 2022, an ambulance took him to Swedish Hospital's ER next door.

The couple had insurance through Cigna, and their explanation of benefits was clear: They would not have to pay anything. However, they were saddled with "balance billing" also known as surprise billing.

That's when the difference between what hospitals or ambulances charge and what insurance companies pay is passed on to the patient.

That's possible because ambulances are not covered by the federal No Surprises Act that went into effect in 2022 and prevents surprise medical billing.

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Couple billed nearly $2K for ambulance ride next door has bill reduced to $0

Jaclyn Allen
5:26 PM, Apr 24, 2023

A federal committee has convened to consider changes and recommendations to change that. This week, on March 15, the committee will submit its final report.

Colorado lawmakers are hoping to tackle the issue on the statewide level.

The legislation would require $36,515 be allocated to the Department of Regulatory Agencies in fiscal year 2024-2025, which would begin on July 1.

The legislation has bipartisan support with Rep. Karen McCormick, D-District 11, Rep. Matt Soper, R-District 54, Sen. Kyle Mullica, D-District 24 and Sen. Mark Baisley, R-District 4, sponsoring the bill.

The bill is scheduled for a hearing on Tuesday, March 19.

If it passes through the legislature, it could take effect in August of this year.

Colorado, U.S. lawmakers hope to end surprise ambulance bills

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