Dear Neighbor – Please Voice Your Support

Nov 16, 2023

Dear Neighbor,

I’m reaching out to ask for your help.

Throughout the past year the local ambulance service providers have coordinated with the NYS Senate and Assembly, and have had great local and State-wide support to advance bills (S.1466/A.250) that address the issue of direct pay for out-of-network ambulance service. These bills have received unanimous legislative support, and Governor Hochul has called this legislation up for review.

This legislation impacts all communities and EMS services throughout New York State.

Throughout New York State, ambulance services are required to respond to emergencies without regard for a patient’s individualities, including their insurance or ability to pay. The cost of service is defined at the local level and is predominantly reimbursed through insurances. And while the costs are defined by local market factors, the reimbursement provided by insurers is defined not by the needs of the patient or community, but instead the needs of the insurer.

For patients who rely on Medicare and Medicaid, ambulance service is reimbursed on a fixed fee schedule that was established in the 1990s, and has not increased enough over time to cover current costs for service. This results in underpayment for services for an often fragile population, that make up the largest (and growing) proportion of our responses.

Commercial health insurances have a history of manipulating the value of ambulance service by attempting to determine if your emergency was medically necessary, by excluding reimbursement for service that doesn’t result in transport to a hospital, and by sending payments to you instead of the ambulance service. What ambulance expenses a commercial health insurer covers is often unclear. Ambulance services aren’t always paid for the service they provide. We expend additional resources educating patients on their insurance, collecting debts, and combating insurance fraud.

These behaviors by commercial insurers are not new. Similar practices were prosecuted in 2009 by then-Attorney General Andrew Cuomo, resulting in establishment of independent organizations such as FairHealth, responsible to improve transparency about medical expenses and insurance coverages. Ambulance services also use these organizations to ensure charges for service is within acceptable norms.

Our highly trained EMTs and Paramedics want to help you when you need us. You should expect your insurance to cover ambulance expenses.

Each resident who calls for an ambulance reasonably expects that service is available and covered by their insurance. Ambulance services often choose to remain out-of-network so they can be appropriately reimbursed by commercial health insurers. From the perspective of the ambulance service providers, negotiation for service rates have not been a part of this the legislation we seek to advance, and our accountability to fair and reasonable practices is not changed.

We simply want all payments currently issued for our service to be sent to us directly, to ensure ambulance service can continue to reliably operate.

I write to urge you to support our cause. This legislation (S.1466/A.250), which passed both houses unanimously, will provide for a more efficient system in delivering the reimbursement to the ambulance service providers who are entitled to it, thereby strengthening the EMS system and ensuring better healthcare for all New Yorkers – including everyone in our community.

Please consider calling the Governor’s office (1-518-474-8390), and use this contact form to voice your support.


Jonathan D. Smith

Chief / CEO, Pittsford Volunteer Ambulance, Inc.

You can see my letter to the Governor here ->