CHARLESTON, W.Va. — The Kanawha County Emergency Ambulance Authority says it’s cancelling its contract with Highmark BlueCross/BlueShield after failing to reach a new agreement focused on raising reimbursement rates.
KCEAA said the current contract will expire Jan. 1, 2026 and at that time those covered by Highmark BCBS will be considered uninsured including those with Medicare Advantage plans.
“We don’t want to be in this situation but they, BlueCross/BlueShield, has the responsibility to pay their fair share of the cost of delivering EMS service to their members and they don’t want to do that,” KCEAA spokesman Tom Susman told MetroNews Thursday.
Highmark Corporate Communications Director Cathy McAlister defended the company’s reimbursement rates.
“Highmark follows CMS standards for paying ambulance care and pays at CMS rates. We provided Kanawha County Emergency Ambulance Authority data that showed that our reimbursement was aligned with the industry and agreed to some select increases,” McAlister told MetroNews. “It was Kanawha County Emergency Ambulance Authority that terminated their agreement with us, per their contact rights. We regret their decision and recognize the challenges faced by EMS providers but believe the issue cannot be resolved by commercially insured individuals alone.”
More than 75 percent of patients transported by KCEAA are covered by government -based insurance plans like PEIA, Medicaid and Medicare. Susman said that doesn’t mean Highmark BCBS can pay lower reimbursement rates for those who are privately insured.
“As a percentage of a total of the business it’s not humongous but we need everybody to pay their fair share,” Susman said.
He added the ambulance authority believes it would be better trying to collect from the patient themselves than to keep getting lower reimbursement from Highmark.
Susman said Highmark has agreed in negotiations to raise reimbursement rates some but not enough.
“We’d like to work this out. We understand they have to manage health care costs but we’ve got to make sure that in the Kanawha County area we have a sustainable EMS agency and part of that is for them to pay their fair share,” Susman said.
KCEAA made several service changes earlier this year to help maneuver around a $4 million dollar deficit and workforce shortage issues.
Susman said Thursday they don’t want to end up like 30 other EMS services in West Virginia that have had to close.
“Part of the problem is these payers (insurance carriers) will not pay what the cost is to provide service and they have a responsibility,” he said.
KCEAA it will not refuse service to anyone who needs it but after Jan. 1 a patient covered by Highmark BCBS will be responsible for the full bill.