Pennsylvania Ambulance Providers Sues Health Insurers
The city of Pittsburgh and 11 other paramedic service providers have joined a suit which pits them and the Ambulance Association of Pennsylvania against statewide Blue Cross Blue Shield health insurers for what it calls “a pattern of attempted extortion.”
The suit accuses the defendants of violating the federal Racketeer Influenced and Corrupt Organization Act by forcing or attempting to force the non-contract ambulance providers into below market rate contracts by refusing to pay them directly for their services. Instead of paying the non-contract providers for their transport services, the insurers have been accused of making payments directly to the patients, who may or may not in turn pay the providers.
The suit contends that providers have the right to be paid directly, whether they have entered into a contract with the insurers or not. By not sending payment to the providers directly, it is estimated that the providers have been “losing millions over the last four years.”
The suit goes on to state that the plaintiffs have also violated state law, including the Quality Health Care Accountability and Protection Act. This may turn into a class action suit involving up to 200 state paramedic services.
The complaint was filed against Capital Blue Cross, Highmark, Hospital Service Association of Northeastern Pennsylvania, Independence Blue Cross, Keystone Health Plan Central and Keystone Health Plan West in the U.S. District Court’s Western Division by attorney Charles Kelly of Kelly Hayden LLC. The city council voted last Thursday to pay $5,000 to Kelly Hayden to represent the city in the suit.
In addition to the city of Pittsburgh and the Ambulance Association of Pennsylvania, the plaintiffs also include Monessen Ambulance Service, Mon Valley Emergency Medical Services, Robinson EMS, Goodwill Hose Company Ambulance Association, Lancaster EMS Association, United Hook & Ladder Co., New Oxford Community Fire Co., Penn Township Volunteer Emergency Services Inc., Tremont Area Ambulance Association, Valley Ambulance Authority, Yoe Fire Company Ambulance Service and Northwest EMS.