An ambulance ride to the hospital could cost more now that the state has ended its practice of offering discounted and special rates to healthcare providers.

On June 30, the Department of Health's Emergency Medical Services branch canceled contracts it had with insurance providers for ambulance service charges. Providers, such as the Hawaii Medical Service Association, had negotiated their own rates for years.

But the Emergency Medical Services branch determined that the special rates allowed one provider to pay less than another for the same service, and state officials decided to end the practice. The state EMS handles the billing and collecting of ambulance fees for the counties, which operate the ambulances.

"We just didn't see the reason for renegotiating the contracts," said Janice Okubo, Health Department spokeswoman. "We looked at rates that were offered in similar communities across the nation, and our rates are very reasonable. We evaluated the contracts with the attorney general's office and determined that there was no need for us to provide a discount."

Depending on the level of care, the state charges a patient from $585 to $659 per ambulance trip to the hospital. The actual cost per transport is about $850, Okubo said.

Eight insurance companies had negotiated special reimbursement rates of $368 to $450 per trip, she said. As a result, Okubo said, the state last year lost about $5.7 million.

On O'ahu alone, ambulance personnel responded to about 74,000 calls from July 1, 2006, to June 30, 2007. Of those calls, 45,335 people were transported.

"In the past, there were some providers that got discounts and some that did not. We felt that it was important to make it equal across the board, otherwise it would be an unfair advantage for some providers," Okubo said.

The Health Department's administrative rules place a cap on the rates, which can be raised a maximum of 10 percent a year, she said. The last rate increase was in July 2007, she said.

But Cliff Cisco, HMSA senior vice president, said canceling the contract and requiring patients to pay the higher rate is the same as a fee increase. He said HMSA currently covers 80 percent of an ambulance trip and the patient is responsible for the balance.

With a higher rate, Cisco said, the patient's share, as well as that of the provider's, will be rising.

"We were in the process of negotiating a new reimbursement, and (the state) made an overriding decision to drop all participating contracts and just do it this way," Cisco said.

He did not have HMSA's old reimbursement rate readily available, but said HMSA had proposed paying a higher rate when the state made its decision.

Although the cost to the patients and healthcare providers will be increasing, ambulance service will not be affected. Both Okubo and Cisco said people should continue to call 911 when an ambulance is needed.

"People should not worry about getting on an ambulance," Cisco said.