Nashua's ambulance charges reversed
American Medical Response increased rates charged to insurance companies in early January but rolled them back this week.
But the short-lived increase had no effect on out-of-pocket charges paid by local residents, city officials said.
"I think there is some misunderstanding," said Kerran Vigroux, director of Public Health for the city. "We have a contract with AMR that caps what they can charge."
Anyone in Nashua who uses AMR ambulance, and who personally pays for the service, cannot be charged more than the government-set rate for Medicare patients plus 25 percent, according to Vigroux.
The agreement, she said, extends for the life of the contract.
Vigroux said her department has received some phone calls from patients who were transported via AMR and then received bills in the mail.
"There were calls because people would see on their bill this large amount, but what they were responsible for was only the Medicare (fee) plus 25 percent," she said.
The higher rate is the price charged to insurance companies that do not have a fee agreement - called a provider contract - with AMR. Health insurers and providers often negotiate contracts setting fees for services.
"That was confusing for people, and we have had to explain that they don't actually have to pay that amount," said Vigroux.
AMR put a rate increase in fees charged for insurance-paid hospital trips into effect at the beginning of the month.
This week, that increase was rolled back to previous insurance rates, which started at about $1,600. Trips requiring more intensive care were raised from $2,300 to $3,260.
Mayor Donnalee Lozeau said Friday that she was not notified of any increase and stressed that any rate increases affecting insurance companies cannot change the amount Nashua residents pay out of pocket. "We have a fixed-rate contract," she said.
Vigroux explained that it was important to have a clause in the two-year contract with AMR that capped the rates. "We knew when we entered into an agreement, that was a standard (practice) that was happening nationally, so it was something we definitely wanted to put in place," said Vigroux, who also serves as chairman of the city's Ambulance Advisory Committee.
Mark Hastings, director of emergency management at Southern New Hampshire Medical Center and a member of the local ambulance committee, said Friday that he is unaware of any complaints or concerns raised by Nashua residents regarding rate increases AMR is charging to insurance companies.
When it announced the increases, the company said it was necessary to defray costs of providing emergency service to Medicare or Medicaid clients and the losses the company incurred taking care of people without insurance.
The Board of Aldermen approved its current contract with the national ambulance company in September 2011, despite objections from four board members who were concerned with the bidding process. Two other ambulance companies also placed bids for the contract, including PrideSTAR of Lowell, Mass., and CAREPLUS of Merrimack.
The city's previous provider, Rockingham Ambulance, shut down at the time because of a decrease in state funds offered to St. Joseph Hospital which operated the ambulances.
In addition to Nashua, AMR also provides ambulance service to the City of Manchester. It is headquartered in Colorado, and services more than 2,100 communities nationwide, according to its website. AMR serves more communities and customers than any other private ambulance service provider in America, states the website. According to Assistant Fire Chief Steven Galipeau, there have been previous, informal talks about the Nashua Fire Department operating its own emergency ambulance service in-house.
"But for a city of this size, it would be a significant investment upfront," said Galipeau, explaining it would not be economically feasible for Nashua to consider that alternative right now.
He said implementing an in-house ambulance operation could potentially cost an initial $4 million, plus additional personnel, plus extra vehicles and supplies.