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New law considered “win-win” for patients, EMS providers

CARLISLE, CUMBERLAND COUNTY, Pa. - Saving patients the burden of out-of-pocket medical costs, while also getting ambulance companies paid. A new state law will help people calling 911 along with those answering the call.

"This is something we frequently encounter, especially with the elderly population," said Nathan Harig, Assistant Chief at Goodwill EMS. "They just need a little help but don't need all the hassle of going to the emergency room."

A person in need of emergency care but it's not serious enough for a trip to the hospital. In this situation, Goodwill EMS will bill the patient who will have to cover the costs out of pocket because up until now most insurance companies won't cover this type of medical care.

"If we encounter a patient who we can treat in their home and leave them in the home," said Harig. "Then there's a benefit to that now that we can seek reimbursement from insurance company or medicaid that before we would either bill the patient or it would be written off."

Act 103 or 2018 will require insurance companies and medicaid to cover the treatment given by EMS providers dispatched by a 911 center without a trip to the hospital.

"Requiring your insurance company, your medicaid pays for us to treat you in the home should be a lot less of a financial burden to patients out there," said Harig. "And will hopefully encourage them to use us more often instead of just ignoring problems for the sake of financial security."

A cost burden off patients but also a cost burden off EMS providers. Aside from the financial aspect, Harig says, he hopes this law will help them evolve and focus on prevention like the way fire departments hand out smoke detectors.

"Now that we have funding to treat someone in their home we can hopefully evolve into hey we've seen this patient a lot, lets be proactive and lets seek a solution to prevent them from falling in the first place. And then reducing our 911 burden and making a safer community."

The Bureau of EMS at the Department of Health still needs to set rules and regulations. It will then be up to each EMS provider to set a fee schedule before this all goes into effect sometime next year.