Kanawha ambulance authority cuts ties with Highmark BCBS WV over low reimbursement rates

by Caity Coyne, West Virginia Watch
October 30, 2025

Starting Jan. 1, individuals carrying health insurance through Highmark BlueCross BlueShield will no longer be covered for any services rendered through the Kanawha County Emergency Ambulance Authority, according to a news release from the authority.

Per the release, the Kanawha ambulance authority is canceling its contract with Highmark after the ambulatory service and insurance agency failed to agree on a new contract that would have seen Highmark “adequately reimburse” KCEAA for its services.

No one will be turned away for service, the release read, but some people who were previously covered will soon be considered uninsured and will be on the hook to pay the full, out of pocket costs of the services rendered.

Highmark BlueCross BlueShield serves about 250,000 people in West Virginia and holds the largest share of the commercial insurance market in the state. 

Cathy McAlister, the director of corporate communications at Highmark BlueCross BlueShield West Virginia said Thursday that the insurance provider follows standards set by the federal Center for Medicare & Medicaid Services and pays those same 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 said in an emailed statement. “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.”

Tom Susman, a spokesman for Kanawha County Emergency Ambulance Authority, said the ambulance authority isn’t asking Highmark to solve all of those challenges, however.“We’re just asking them to pay their fair share and not have the other folks in Kanawha County pick up their tab,” Susman said. “That’s all this is.”

According to the release from the ambulance authority, Highmark agreed in negotiations to increase payments by “a small amount.” That amount, however, was “not enough” for the ambulance authority to sustain its services.

Susman said most of the people who will be impacted by the contract termination are ones who receive Highmark BlueCross BlueShield coverage individually or commercially through their employers.

If those individuals are treated or transported by KCEAA starting on Jan. 1, they will be charged the full cost of providing EMS services without any insurance coverage or discount.

People who are covered by Medicare or Medicare Advantage plans through Highmark should still receive the insured discount for emergency transportations due to federal regulations that require a certain amount of coverage — and reimbursement — for Medicare beneficiaries, Susman said. Non-emergency services, however, may not be covered at the same level.

Susman said that the ambulance service is “just trying to be paid fairly.” 

“Something has got to give. We’re not asking for a horrible amount of money here; we’re asking for enough to keep us afloat and for what is fair for the services we’re providing,” Susman said. “We as a service provider don’t have the luxury of saying no [to patients], and of course we wouldn’t turn anyone down because of their insurance — but these services do cost money and we want what we’re owed.”

Susman said about 75% of revenue for Kanawha’s ambulance authority comes from reimbursements after treating patients covered by the Public Employees Insurance Agency, Medicare and Medicaid. 

Highmark, he continued, paid less in reimbursement rates than PEIA. 

“We are sorry that Highmark BlueCross BlueShield doesn’t see the need to support KCEAA’s services adequately,” said Monica Mason, executive director of KCEAA, in the news release. “This is not something we want to do. Unfortunately, KCEAA is fighting a deficit and must require all insurers to pay their fair share for its services.”

KCEAA said in its release that it “remains hopeful” that a better contract can be negotiated with Highmark over the next 60 days. The current contract requires a 30-day notice for cancellation. By giving the 60 days, Susman said older people looking at Medicare Advantage plans and companies deciding health insurance for their employees will have enough time to consider other options since KCEAA will no longer be an in-network provider.

Chris Hall, the executive director of the West Virginia EMS Coalition, said the pressure building at KCEAA is similar to that for ambulance providers throughout the state, and “inadequate” reimbursement rates are a large part of the issue.

If EMS agencies receive low reimbursement rates, the remaining cost for services — up to almost $500 per an ambulance call, Hall said — are passed on to taxpayers. 

“EMS relies solely on patient care revenue and taxpayer support to fund its operations. Insurance reimbursements typically fall drastically short of covering the actual costs. And like a hospital emergency room, EMS is obligated to provide care regardless of a patient’s insurance status,” Hall said in an emailed statement. “If EMS agencies are underpaid, taxpayers bear the cost or emergency services become less available, which strains local budgets and jeopardizes care quality and access.”

Mason, in the news release, said that an increase in reimbursements is necessary to keep ambulance services operating in Kanawha County.

“In the past five years, more than 30 EMS providers across West Virginia have disbanded partly because some insurers have not paid them sufficiently to support their services,” Mason said. “We cannot let that happen to KCEAA.”

West Virginia Watch is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. West Virginia Watch maintains editorial independence. Contact Editor Leann Ray for questions: info@westvirginiawatch.com.