Air ambulances save lives. When a health emergency strikes, doctors or first responders call upon air ambulances to transport patients to the closest, most appropriate hospital quickly so they can get the care they need. In most cases, the patient is unable to choose how they are transported, and, in every case, the air ambulance goes when it is called.
But there’s the problem. If the patient has private insurance, this can sometimes lead to a massive uncovered bill. Getting a balance bill after a medical event can be stressful and scary. But some of the proposed solutions to addressing balance billing, particularly for the air ambulance industry, don’t tackle the root cause of these bills. In some cases, they could adversely impact Americans’ ability to access life-saving care. Congress must find a solution that protects access to emergency air ambulance services and takes patients out of the middle.
Balance billing occurs when a patient’s private insurance fails to cover the cost of care and holds the patient responsible for paying the balance. Air ambulance providers never want a patient to receive a bill they didn’t expect or can’t afford. But insurers make that difficult by denying coverage almost 50 percent of time based on “medical necessity” or network status, or by paying the patient directly rather than the provider. Put simply, balance bills happen because insurance companies don’t want to pay for the cost of service.
Denials based on “medical necessity” can be especially frustrating for patients who have been flown by air ambulance in an emergency. Ninety percent of patients flown by air ambulance have suffered a serious cardiac event, like a stroke or heart attack, or another serious trauma. The attending medical professional or first responder on the scene deploys an air ambulance because they believe the patient’s condition requires the fastest transportation to the closest, most appropriate facility. Air ambulances never self-deploy — they go when they are called, regardless of the patient’s ability to pay. Therefore, these transports are, by their very nature, medically necessary.
The issue of network status for air ambulance providers is equally challenging. Insurers often believe that narrow networks are necessary to reduce costs, even though there is little evidence that this does so. But, as insurers continue to pursue narrowing networks in an attempt to reduce their costs and maintain their profit margins, more and more patients may receive a balance bill.
Air medical providers want to go in-network and make every effort to negotiate in good faith to reach reasonable contracts with insurance companies. While some insurers do bring air medical providers into their networks, some refuse even to consider it, leaving patients at risk of a balance bill. How is a patient supposed to ask if the air ambulance is in-network when he is unconscious or suffering from a life-threatening injury?
As a result, air ambulance providers have established robust patient advocacy programs to help patients navigate the insurance appeals process and, in many cases, reduce the balance due. But that is not a sustainable solution and Americans agree. The Kaiser poll showed that only 5% of Americans said the provider should bear the full cost.
Finally, reimbursement from commercial health insurance varies widely across the country, ranging from low multiples of Medicare to payment at or near billed charges. Air ambulance providers depend on insurance reimbursement as their main source of funding due to the significant cost shortfall of Medicare/Medicaid reimbursement. On average, Medicare reimburses only about half the cost of an air medical flight. Because roughly 70% of air medical transport patients are covered by these government programs or have no insurance, emergency air medical transports are severely underpaid for seven out of ten transports.
Studies have shown that for a small increase in monthly premium, emergency air ambulance services can be covered by private insurance. For instance, a legislative study in Montana showed that for only $1.70 more per month in premium, air medical transportation can be reimbursed in full without burdening patients with bills.
As Congress looks at the issue of balance billing, it must focus its attention on insurers, who have the ability to ensure emergency care is covered and patients are not stuck with a bill. It’s time for insurers to step up and do the right thing.
Carter Johnson is spokesperson for Save Our Air Medical Resources (SOAR), a national campaign dedicated to preserving access to emergency air medical services.
