The decision follows recent legislation from the state, Senate Bill 2476, which was designed to protect patients from being saddled with paying for the difference between the cost and what their health insurance covers in terms of emergency transportation.
The backstory
During the 88th Texas Legislature, SB 2476 was passed and signed by Gov. Greg Abbott on June 18 last year. Among other things, the law removes patients from out-of-network billing disputes and grants power to the local government to determine how local EMS services are funded, according to agenda documents.
For Pearland, SB 2476 allows the city to set the EMS billing fees associated with ambulance transports and requires the insurance companies, which are regulated by the Texas Department of Insurance, to pay those fees. In return, Pearland cannot require the patient to pay the balance of the bill, also known as balance billing.
Balance billing is when a provider bills a patient for the difference between the provider’s charge and the allowed amount, or the maximum payment their insurance covers, according to HealthCare.gov. For example, if the provider’s charge is $100, and the allowed amount is $70, the provider may bill the patient for the remaining $30.
In their own words
The Texas EMS Alliance applauded the state Legislature’s choice to allow the "nation’s model framework" for out-of-network EMS billing.
“SB 2476 will prohibit the balance billing of patients for out-of-network services by ground EMS,” the organization said in a May 19 news release. “In exchange, commercial health plans will be directed to reimburse out-of-network ground EMS agencies at the rates set by local governmental entities.”
