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DOWNTOWN - Twenty ambulance services in southwestern Pennsylvania, plus the City of Pittsburgh, filed a lawsuit this month against Highmark Inc. seeking additional payment for emergency transportation they provided for members of Highmark's SecurityBlue Medicare HMO over a several-year period. The class action suit claims that Highmark refused to pay these ambulance service providers the full charge for emergency transports and instead paid a lower Medicare rate for the services. The suit seeks reimbursement for the difference.
"Ambulance companies have had the right to be paid their normal charges, in full, for their ambulance services rather than a reduced Medicare-approved rate," the plaintiffs said in the court filing.
The attorney representing the ambulance companies, Charles Kelly, said the total dollar amount between what Highmark reimbursed the ambulance companies and the full ambulance service charges will not be known until after the discovery process.
However, one source involved in the case, who did not wish to be identified, speculated that the amount of money the ambulance companies wish to recoup is "in the millions." Jack Metz, executive director of the Ambulance Association of Pennsylvania, a 250-member organization based in King of Prussia, estimated that the amount of full...