The shock of a medical emergency is often followed by the a second jolt from a sky high air ambulance bill. An out-of-network ambulance service and “not medically necessary” decision could mean huge expense to the insured.Medical emergencies usually strike with no warning and the victim or loved ones must call 911 for an ambulance. Seconds count and there is no time to shop ambulance services for a provider that is in-network with the victim’s health insurance plan. If the service provider is out-of-network, later the insured often receives a bill for the balance of the cost. That bill creates another crisis, a financial one.
In an emergency you can’t shop ambulance providers
This is especially true if air transport is used. A Consumer Reports article describes two situations that can lead to crushing out-of-pocket costs for the patient. The first is whether that provider is in-network for the victim’s insurance or out-of-network in which case insurance pays much less toward the cost. The second situation is whether the air transport was medically necessary when ground transport would have been sufficient.
Caught in the intensity of the moment, patients or loved ones must make pressured, fast decisions. They do not have control over who the air ambulance provider is, to question whether it is in-network with insurance and if air transport is medically necessary.
CR says that the average air ambulance bill is $30,000. Why so high? Rick Sherlock of the Association of Air Medical Services says that because Medicare and Medicaid pay a maximum of $6,000 the services must make up costs by charging more to privately insured patients.
Government consumer protections stymied…by government
Real Clear Health reports that several states’ legislatures have begun trying to address the need for consumer protection. However they face opposition from two federal court decisions holding that the Airline Deregulation Act of 1978 forbids states from interfering in pricing for air ambulance services, including allowing insurance caps on reimbursement. That law deregulated the passenger airline industry, but the courts have cited it in medical flight charges as well.
The 10th Circuit Court of Appeals held that for states to regulate air ambulance cost and reimbursement, the ADA will need to be amended by Congress. States now are turning their attention toward persuading members of the House and Senate to do so.
Balance billing for ground ambulance service has not received as much attention, given that air service is so much more expensive. Balance billing legislation has been proposed in Congress previously, but which did not address ambulance services.
The RCH article concludes noting that 2018 being an election year, new state legislatures and a new Congress will be seated in January 2019, and that consumers should contact their legislators at the state and federal level to call these issues to their attention.
What can you do about an air ambulance bill?
How can you protect yourself from an outrageous air ambulance bill? First, know your health policy terms regarding the service before a crisis ever happens, and find out the answer to some important questions. Does your policy pay any air ambulance provider the same amount whether in-network or not? How much does your insurance pay toward an air ambulance bill? Who does your insurance company recognize as having authority in an emergency to decide if air transport is medically necessary? Finally, is air ambulance transport cost included under the cost cap of your “maximum out-of-pocket” provision of your policy? Read your policy and call your insurance carrier to ask questions.
If you have an emergency where there is no question that life flight is necessary, you must do it. If the injury or health crisis is not clearly life threatening and a medical provider or emergency responder says it is needed, ask them to explain the necessity. If they are insistent, you should defer to his or her professional judgment. You will cite that later on if the insurance company decides it was not medically necessary.
In a dispute over a large out of pocket bill, first appeal to the ambulance company itself to give you a break on the balance owed. Some will work with you to lower the cost to a level you can manage. If you get no cooperation, contact your insurance company for assistance toward additional insurance payment or pressure on the ambulance provider.
Finally, again before an emergency strikes, contact local, state and federal representatives to work on helping protect consumers from sky high life flight bills. At the city and county level, many local governments have out sourced EMS services to private companies which are charging huge bills. Explain this problem to your local government officials and request that they return services to local government control.
At the state level contact your state legislative representatives to pressure the U.S. Congress to amend the Air Deregulation Act of 1978 to make room for states to be able to regulate air ambulance costs. Then, contact your own U.S. Congress member and Senator to push through that change.