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Copyright 1999 Federal Document Clearing House, Inc.  
Federal Document Clearing House Congressional Testimony

March 24, 1999


LENGTH: 924 words


March 24, 1999 Written Testimony of Mark D. Meijer American Ambulance Association Chairman Bilirakis, Ranking Minority Member Brown and members of the Subcommittee, on behalf of the American Ambulance Association (AAA), thank you for allowing us to submit written testimony for the hearing record. My name is Mark Meijer, and I am president of the American Ambulance Association and a provider of emergency ambulance services in Kalamazoo, Grand Rapids, and other parts of west Michigan. The American Ambulance Association represents more than 650 ambulance providers from all fifty states. As president of the AAA, I hear from ambulance service providers across the country who are being denied reimbursement by managed care plans for ambulance services that any reasonable person would consider a medical emergency and cause for calling 91 1. As an ambulance service provider in Michigan, I have firsthand knowledge of numerous instances where managed care plans denied reimbursement for similar legitimate claims. It is with these experiences in mind that I implore Congress to pass managed care reform legislation that contains an emergency services provision applying the "prudent layperson" standard to emergency ambulance services in addition to the emergency room services expressed in the bills. I do want to be clear on a number of points. We are not asking for a mandated benefit. We are asking that this requirement apply only to plans that provide coverage for ambulance services. In addition, we are not suggesting that every medical emergency in which the "prudent layperson" standard might be invoked would necessarily require an ambulance. We propose a second "prudent layperson" standard by which, not only must there be a medical emergency, but that ambulance transportation must be considered medically necessary by a "prudent layperson." We have sought to keep our proposal deliberately narrow, but fair to those that are faced with calling for emergency medical help. The recent growth of managed care has increased concern about whether adequate emergency medical services are being provided to participants of managed care plans. That is, as we understand it, why this legislation is before you today. Chief among these concerns is the extent to which managed care plans are second- guessing victims of perceived medical emergencies when they seek emergency medical care. This second-guessing can result in the loss of precious time that could worsen a patient's sudden illness or injury, and in fact increase mortality and morbidity as well as cost to payers. The response by Congress has been very gratifying. While there are any number of controversies attached to the various approaches to regulating managed care, there seems to be a broad consensus on the need of a provision covering emergency medical care. The problem with ambulance coverage is that the emergency medical services provision in all of these bills is based on a law, the Emergency Medical Treatment and Active Labor Act (EMTALA), that does not address pre-hospital care and thus does not include emergency ambulance services. Even those bills seeking to broaden coverage, for instance, by including the term "ancillary services" among those services that should be provided, are inadequate, according to our counsel and more importantly real life experience. The fact is that EMTALA begins at the hospital door, so "ancillary services" would only cover services provided in a hospital. In order to ensure that emergency ambulance services are indeed covered, managed care reform legislation must explicitly refer to ambulance services. The fact that emergency ambulance services are not covered is very troubling considering that millions of medical emergencies a year begin with a 91 1 call. The dispatch of an ambulance is often the very first response to an emergency medical episode. Prompt attention by emergency medical personnel from an ambulance can be every bit as critical as emergency room care in such situations. Failure to reimburse for emergency ambulance services may either discourage patients from utilizing life-saving emergency care or surprise them with bills for emergency ambulance services that they did not expect. When a medical emergency strikes, whether real or perceived, nobody is thinking of reimbursement. Neither the individual experiencing the emergency, their family or friends or their care-givers should have to worry, at that moment, who is paying for their care. Similarly, ambulance providers respond to such emergencies with one thought in mind: the health and wellbeing of the patient. Ambulance providers respond to emergencies regardless of the patient's Ability to pay or the patient's insurance company's willingness to pay. Managed care plans should not be allowed to take advantage of this commitment by the ambulance industry. If we require them to pay for emergency room care, we should require them to pay for ambulance care as well. As members of the House Subcommittee with jurisdiction over this issue, I hope that you will work to include language specific to emergency ambulance services. Your assistance is critical to keeping this front-line access to emergency medical services available to health care plan participants across the nation. Once again, thank you for allowing the American Ambulance Association to submit written testimony for the record. I would be happy to respond to any follow-up written questions that members of the subcommittee may have on the issue.

LOAD-DATE: April 6, 1999

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