New Hampshire House approves a potential solution to surprise ambulance billing

Amid a yearslong debate over how to make sure ambulance patients aren’t surprised with massive bills even when they have health insurance, the New Hampshire House of Representatives approved a bill aimed at solving the issue.

The House voted, 250-85, to approve House Bill 316, which seeks to end balance billing — the practice of patients being charged the difference between what an ambulance ride costs and what their insurance company agrees to cover — and establish a mandatory rate at which insurers must pay ambulance providers. If enacted, the bill will direct the state Insurance Department to establish a rate every two years based on the work of an independent actuarial and accounting expert, and ambulance providers would be bound to that rate. It would also prohibit the insurer covering the ambulance ride from passing any of the cost onto patients outside what their policy specifies.

The bill had the support of Insurance Commissioner D.J. Bettencourt who, in January, said it was “fundamentally unfair to stick the consumers in the middle of this dispute and give them a bill that they don’t understand, that they didn’t know was coming and for many of them, they can’t afford.” He called the bill “not perfect,” but “the most viable solution to a very, very difficult problem.”

Earlier this year, the Insurance Department and Public Consulting Group LLC released a report on what the initial rate would be. It recommends a base rate of 202% of the federal Medicare rate for an ambulance or 209% of the Medicare rate per mile the ambulance travels. After two years, the state would update that rate.

Opposition to the bill pointed to that rate as too low. Rep. Jerry Stringham, a Lincoln Democrat, argued the bill “would be devastating to our ambulance providers.” He said there was a “key flaw” in how the department and its consulting firm derived that number. He argued it shouldn’t have factored in the property tax funds ambulance providers receive due to differences in how much localities provide their ambulance providers.

The bill will have to be approved by the Senate and governor before it can become law.