Patients of air ambulance services need coverage when it counts

Many important issues were debated during the recent midterm elections, but few more than Americans’ desire to fix our health-care system. Whether its drug prices or the cost of emergency room visits, pre-existing conditions or the opioid epidemic, patients are often stuck in the middle between providers of care and how to pay for services.

Patients of air ambulance services are no different. While these issues are complex and the solutions challenging, it’s clear that one industry in particular needs to do more for patients — private insurers. Consumers who pay monthly premiums for insurance deserve to know they’ll have coverage when it counts.

ADVERTISEMENT
When an emergency strikes, like a heart attack, stroke or traumatic injury, air medical providers help transport patients to the closest most appropriate health care facility, so they can get the care they need as quickly as possible. In these emergency cases, speed can be a matter of life or death.

While many private insurers do right by their clients and cover air medical transportation at a fair rate, many pay far below the cost of the services by claiming the transport wasn’t “medically necessary.”

However, air medical providers do not self-deploy. Rather, they are called to respond by medical professionals or first responders who have assessed the specific patient and determined that air transport is the best option for that patient’s care.

This kind of behavior is not unique to air medical services. Across the health-care system, some private insurers have been shirking their responsibility to adequately cover emergency room visits, leaving patients stuck with large bills for care that was necessary for their health. It begs the question — if you can’t rely on private insurance to cover you or a loved one in an emergency, what is insurance for?

Another tactic used by insurers to reduce their costs and maintain profit margins is to pursue narrow networks and leave providers of air medical services out-of-network. Air medical providers want and are working to go in-network with insurance providers and believe that they can work together to come to an agreement that is best for patients and communities.

For example, in August of last year, Air Methods and Air Evac, providers of air medical services, announced in-network agreements with Anthem Blue Cross and Blue Shield in Missouri to offer emergency services at discounted in-network rates, taking the patient out of the middle and ensuring those services would be covered.

The agreements also helped Missourians with Anthem insurance to avoid balance billing, the practice of the health-care provider billing a patient for the difference between the plan’s reimbursement and the medical charges.

Most air medical providers have robust patient advocacy programs to help patients navigate the complexities of the insurance reimbursement system and assist with insurance appeals when air-medical care and transportation is an out-of-network benefit and insurers are either under-paying or denying coverage. But that shouldn’t be necessary, and wouldn’t be, if insurers did right by patients.

To truly take patients out of the middle and address the issue of balance billing, we must find a solution to the root of the problem — the chronic under-reimbursement of Medicare and Medicaid for air medical services. Seventy percent of patients transported by air are covered by either one of these government programs or have no insurance at all.

This vast under-reimbursement means the rest of the system must offset the cost of delivering care, placing an unfair added burden onto those with private insurance. Congress must update the reimbursement rates, which haven’t been updated in two decades, to reflect the actual cost of providing care.

In 2018, legislation that would do just that received bipartisan support from members of Congress across the nation, and in particular from those who represent rural communities where access to health-care continues to shrink due to hospital closures and service reductions. This year, Congress must pass that legislation.

Calling for insurers to work with air medical providers to go in-network and reimburse for these life-saving services, coupled with federal legislation adjusting government payer reimbursement, is not only in the best interest of patients and communities, it’s the right thing to do.

Carter Johnson is the spokesperson for the Save Our Air Medical Resources (SOAR) Campaign, a national campaign dedicated to preserving access to emergency air medical services for Americans across the country.