Congress has eliminated “surprise air ambulance bills” as part of the just-passed federal Covid relief bill. Section 105 of the measure provides major relief for air ambulance companies and patients.
The bill would effectively end health insurance company claim payment denials for transports that are “out-of-network,” establish independent resolution for disputed claims, mandate air ambulance data collection on costs and quality, and form a federal air ambulance advisory committee to examine best practices. The nation’s air ambulance companies had long been criticized—often in high-profile media stories—for saddling patients with transport bills that can run into the tens of thousands of dollars.
However, the bill does not totally eliminate patient financial responsibility—they would still be required to satisfy charges equivalent to their in-network deductible. Air ambulance companies and benefits payers would have 30 days to settle claims before taking any disputes to voluntary binding arbitration/independent dispute resolution (IDR).
Air ambulance industry lobby Association of Air Medical Services (AAMS) expressed support for the intent of the legislation but cautioned it could create additional problems for its members. In a prepared statement circulated yesterday, AAMS warned, “hile the entire healthcare community is united in advocating for a solution to balance billing that takes the patient out of the middle of billing disputes, it cannot be done in a way that sacrifices healthcare services, especially during this unprecedented global health emergency.”
Specifically, AAMS took the legislation to task for “adding several new considerations to the arbitration process, such as the consideration of the median-in-network rate—that would be difficult to determine, especially in certain areas of the United States—it would also require the arbitration process to consider aspects of training and quality of the provider, as well as the vehicle (in this case, the aircraft) used to transport the patient. While these are important factors to consider in payment, there are no nationally recognized data metrics on which to consider these factors, and they could be used to favor insurers in the arbitration process.”
Perhaps most troubling to the industry is a provision in the legislation that directs the IDR entity to “not consider usual and customary charges” in settling payment disputes between air ambulance providers and health insurers.
Before the passage of this legislation, air ambulance companies had been dealing with private insurance payment problems by establishing in-network agreements with health insurers or selling annual “memberships” directly to the general public that covered all or part of transport costs.
The bill does nothing to immediately remedy long-held industry concerns that Medicare and Medicaid covered transports are reimbursed at rates substantially below costs. Patients covered under these federal and state programs represent 70 percent of all transports, according to AAMS. However, the mandatory cost data collection section of the bill could generate information to persuade Congress to raise these reimbursement rates in the future.