Just two items today.

First, the story on the increased cost of public ambulance service is more complicated and potentially disruptive than reported yesterday by the Advertiser.

The ‘Tiser story focused on the increased cost of ambulance service following the state’s Emergency Medical Services branch decision to drop its contracts with insurers. The story explained that EMS services are provided by the counties, but billing is done by the state.

As a so-called “preferred provider”, EMS billed HMSA and other insurers, which then paid a negotiated and discounted rate for ambulance service to insured clients. Of the negotiated or “eligible” cost, HMSA paid 80% and the insured patient would pay 20%.

But now that the state is no longer a participating provider under HMSA and other insurance plans, patients will apparently have to be billed directly and apply for a partial reimbursement from their insurer. They’ll now have to pay the full cost up front, not the discounted cost negotiated and paid previously. And they will receive reimbursements based on the much lower “nonparticipating provider” rates. So it promises to be a double hit on consumers when they are most vulnerable.

An article in HMSA’s Island Scene magazine explained the higher costs that members experience when choosing (or forced to choose) a nonparticipating provider.

Going out of network means there’s no HMSA agreement with the provider. Without this protection, here are just two of the challenges you’ll face:

You’ll be required to pay upfront in full for the services you receive, especially for out-of-network services on the Mainland. Participating providers in Hawai‘i and BlueCard preferred providers on the Mainland will generally bill you for your copayment after HMSA’s payment has been made.

You will usually have a large amount to pay out of pocket because our reimbursement to you is based on eligible charges for preferred or participating providers. In addition, many of our plans pay lower percentages (and often have a deductible) for nonparticipating provider services.

And what happens when patients spend their reimbursement checks but fail to pay the original bill for ambulance service?

The Advertiser quotes a Health Department spokeswoman who said that there seemed to be no benefit to the state in continuing as a participating provider. I can’t help wondering if they considered the cost of collecting all those bills from individual patients. It sounds like a costly process with lots of political implications.

We’ll see soon enough.

Second: Ask an idle question, as I did yesterday concerning attorney John Komeiji’s appointment as VP and General Counsel at Hawaiian Telcom, and you might stumble on interesting issues.

One rumor floated my way is that Komeiji’s longtime law partner, Jeff Watanabe, has wanted to pursue a merger between Hawaiian Electric and Hawaiian Telcom. According to this tale–and that’s all it is right now–the merger idea was opposed by former HEI chairman and CEO Bob Clarke, who retired in 2006, and HECO president and CEO, Michael May, who will retire August 1. HECO is a subsidiary of HEI. With them out of the way, so the story goes, the potential merger becomes more of a possibility.

And there are enough interlocks to make the suggestion at least plausible.

When Clarke retired, Watanabe was named chairman of Hawaiian Electric Industries.

When Komeiji moved to Hawaiian Telcom, the company’s former general counsel, Alan Oshima, was appointed to another executive position as “senior advisor” and named to the company’s board of directors. At the same time, Oshima was appointed to the HECO board.

And Hawaiian Electric’s former chief financial officer, Eric Yeaman, who became HECO’s chief operating officer in February 2008, was named president and CEO of Hawaiian Telcom just three months later.

The web site of Xanthus International Consulting describes a contract to develop a “telecommunications strategic master plan” for Hawaii Electric, including “Recommendations on partnering, leasing, outsourcing, and ownership of telecommunication facilities.”

I have no idea if an Uber Utility of the kind created by such a merger would be able to pass an antitrust review, although Hawaiian Telcom is certainly less of a monopoly than it once was. But there appear to be enough new links between the companies to trigger a basic “if there’s smoke, maybe there’s a fire” reaction. Although it could all turn out to be simply one more reflection of the tight group in the middle of Hawaii’s power elite.