Copyright 1999 Federal Document Clearing House, Inc.
Federal Document Clearing House Congressional Testimony
March 24, 1999
SECTION: CAPITOL HILL HEARING TESTIMONY
LENGTH: 924 words
HEADLINE:
TESTIMONY March 24, 1999 MARK D. MEIJER HOUSE COMMERCE HEALTH
AND ENVIRONMENT PATIENT ACCESS TO HEALTH CARE INFORMATION
BODY:
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