There have been many articles written on air ambulance bills recently, and this media spotlight is much needed and overdue. Historically, this service has been an issue, and unfortunately continues to be a problem as the cost for this service continues to soar.
“Aligned with increases in costs for both airplane and helicopter air ambulance transport, average estimated air ambulance costs rose 76.4% from 2017 to 2020,” according to Robin Gelburd, JD, president of FAIR Health. The Association of Air Medical Services reported that more than 550,000 patients in the United States use air ambulance services every year. Furthermore, it is estimated that approximately 75% of all air ambulance usage is out-of-network.
Why is this the case? Typically, air ambulance providers are not part of an insurance or medical network. Unfortunately, the medical necessity of an air ambulance from one facility to another facility is most often determined by the provider – with little to no oversight – and with little to no regard of the financial impact this service may have on their patient.
As the saying goes, the “fox guarding the hen house” rarely turns out well for the hen. In our case, the hen is the Self-Insured Plan and the member. And the fox, well I think we all know who that is. What does this potential mean, especially for the patient? Possible balance billing. While the No Surprises Act that took effect in January of 2022 is intended to protect consumers, it should be anticipated that this legislation will be challenged much to the extent that medical providers are doing.
Allowing the provider to determine the medical necessity of the air transportation, and the selection of the provider of the air transport, can lead to the Plan or the member footing an extraordinary cost. That said, it’s also important to note that while a situation may require an air ambulance, the cost for the service is often predatorial, especially in rural areas where the availability of air transportation services is limited.
Economics 101 teaches us that competition brings down price. So, how do you bring down air ambulance price? Both the Plan and the TPA need to collaborate and work with the medical provider and/or patient to have the air ambulance companies compete for the business. This can be done if the Plan requires preauthorization for air ambulance service from facility to facility.
To clarify, this editorial is not addressing emergencies that require air transportation from an accident to the hospital, where time is of the essence. This opinion is about patients that are stable at one facility but need to be transported to another facility for their continued medical care. This is where a Plan can step in through the preauthorization process to ensure the transportation is medically necessary, and if so, then reach out to air ambulance companies serving that area for the most competitive pricing. It’s critical that the air ambulance secures the preauthorization. Under no circumstances should an air ambulance or any medical provider expect that the patient is aware of potential financial repercussion of such services. For example, the case of the $489,000 air ambulance ride uncovers how a couple ended up with a $489,000 air ambulance bill. It’s important that the Plan/TPA are willing to protect their member’s interest from predatorial practices.
While we cannot share the specifics of a case, USBenefits Insurance Services, LLC recently had a non-emergency air ambulance bill of more than $450,000 for services from the West Coast to the Midwest. To add to the pain of the already inflated cost, the patient did not require any medical attention on the flight and there was another $450,000 for the return trip back to the West Coast. Yes, an air ambulance bill for almost a million dollars. To put this into perspective, if this air transportation had been preauthorized, the cost is estimated to be in the $40,000 range. Needless to say, this air ambulance bill is being challenged and negotiated.
The above example may appear self-serving to the stop loss carrier’s interest, however the appropriate risk management practices among all parties ultimately benefits the employer’s loss experience, hence their future premiums. While the Plan and TPA employ preauthorization requirements, working in concert with the stop loss carrier, such as USBenefits, can be instrumental in managing costs and possibly protecting the member’s financial interest.
USBenefits invites your questions and if you are not already partner, please contact us. Your goal is our goal – to provide the best possible outcome for the employer