National Association of Insurance Commissioners (NAIC) has recently issued an alert with regards to air ambulance insurance coverage. The alert goes on to point out that more and more people are getting buried under the air ambulance cost burden when insurance providers fail to cover the costs. It estimates that an average air ambulance flight is about 52 miles and the costs can vary between 12 to 15 thousand dollars and in some cases can exceed 100,000 dollars.
Why is Air Ambulance Transport so Expensive?
People often wonder why air ambulance transport is so expensive. One of the reasons is, unlike countries such as UK where air ambulances are usually run by charities, in the US, these are mostly run commercial operators. The initial cost of an air ambulance itself is a whopping 6 million dollars on average. The companies obviously want to cover the cost quicker. When you add the cost of medical supplies, aircraft maintenance, and air ambulance specialists, the amount goes even higher.
Getting to Know Your Air Ambulance Transport Coverage is Vital
For one, international air ambulance services are not covered by Medicare. It is almost impossible to negotiate the rates when medical experts suggest that air ambulance services are a must for patient survival. However, it is wise to know some things beforehand. Learn about the air ambulance service providers that your insurance covers. Know that there is a cost attached when a family member or members accompany the patient. Also some policies only cover certain types of aircrafts.
Simple Steps to Ensure Adequate Air Ambulance Transport Coverage
The best time to think about air ambulance transport coverage is now, when you have no medical emergency. Read your health insurance policy closely and find out about the coverage that it provides. If your insurance company has provisions for extra coverage, pay an additional amount to get such facilities. If your insurance company fails to offer you adequate air ambulance transport coverage, it is wise to look for another company that does. In the end, you don’t want to get into a financial obligation that you cannot carry.
Understanding what constitutes an air ambulance according to Medicare is necessary. The fact ensures that you get into an aircraft that is equipped enough to take care of you or your loved ones. According to “Medicare Benefit Policy Manual,” the air ambulance needs to be equipped and designed such that it can be of use during emergency and nonemergency situations. It is also essential that a US air ambulance or worldwide air ambulance service complies with the State as well as local laws.
Air Ambulance Equipment Requirements According to Medicare
The medical flight must be equipped with linens, stretcher, medical supplies for an emergency, oxygen supplies and equipment, and other vital emergency lifesavers or life-sustenance equipment. It must also contain support equipment such as neck and back boards, inflatable arm and leg splints. The air ambulance must be complete with necessary signage that signifies it is a medical flight. Telecommunication equipment must be present in accordance with the State or local law. In other words, there should be one wireless telephone or two-way voice radio at the minimum.
Adequate Staffing of Air Ambulance According to Medicare
If a basic life support air ambulance is chosen, it must have two people at the minimum with at least one of them being a certified EMT or emergency medical technician. The certification must have been granted by the state or local authority. The person must have legal authorization to operate lifesaving equipment onboard the medical flight. Any advanced life support air ambulance too must be staffed with two people with at least one being an EMT paramedic or EMT intermediate.
Statement of Compliance to be Furnished by Air Ambulance Service Provider
A statement that signifies compliance to norms laid down by Medicare is necessary for reimbursements. Medicare might ask the air ambulance service provider to furnish these at its discretion, although the information might not be asked for with every flight. The documentary evidence must contain letters from State or local authorities such as certificates, permits and licenses to name a few. Although checking for compliance is not a beneficiary’s responsibility, keeping oneself informed always helps.
We’ve already discussed situations where Medicare covers medical flight costs. It must be noted in this regard that the coverage is almost always given only when there is an emergency. What if there is a situation where you feel that you are entitled for medical flight coverage by Medicare but the company that provides medical flight services feels otherwise? This is the question we try and answer here.
Disagreement Pertaining to Medical Flight Need
If the medical flight company believes that your situation warrants its service, it will have no problem carrying you to the desired destination. However, if it feels that you do not need medical flight services, you might be asked to sign Advance Beneficiary Notice of Noncoverage (ABN). If you strongly believe that Medicare will cover the medical flight cost later, you can sign this piece of paper and get well on your way to the desired destination. The medical flight service provider would have no qualms about it. However, there are some aspects you need to keep in mind.
You Might Have to Pay for the Medical Flight in Advance
Signing the ABN also means that you would bear the cost of the medical flight if Medicare does not cover it. The air ambulance company may ask you to pay the costs in advance and ask you to recover it from Medicare later. It is necessary that the company asks you to sign this document as, otherwise, it may be held responsible for the costs incurred (and not you) in case Medicare does not cover the medical flight cost. You will never be asked to sign an ABN when there is an emergency.
If you refuse to sign an ABN, the medical flight service provider might still take you. Even in a circumstance like this, you may have to pay out of pocket if Medicare refuses to cover the medical flight cost.
Death of a loved one is always a sad scenario and the cost of transportation is the last thing that lurks your mind at that point. However, it pays to understand the Medicare coverage for air ambulance flights when there is death. Here, we discuss three possible scenarios and how Medicare treats each of these with respect to cost coverage of air ambulance flights.
Death Prior to Boarding the Air Ambulance Flights
Let’s suppose that decision to transport through air ambulance flights has already been taken. However, the patient dies just before boarding the air ambulance. In this scenario, if the dispatcher still has a “reasonable” opportunity to inform the pilot to abort the air ambulance flight and the aircraft has not taken off (even though it is taxied and is cleared to go), the payment from Medicare would be zero. You can still go ahead with carrying the patient to the desired destination but Medicare does not cover such air ambulance flights.
Death after Air Ambulance Flights Takeoff to Point of Pick-up
Now, we take the scenario where air ambulance flights take off for point of pick-up but the patient dies before loading him or her to the aircraft. In such cases, the air ambulance flights are paid adequate airbase rate without mileage or rural adjustment. A QL modifier will have to be used during the claim in this situation.
Death after the Patient is Loaded to the Air Ambulance Flights
Unfortunately, the patient dies during the flight or upon transfer to the receiving facility. Here, Medicare provides the coverage as if the patient was still alive. The death still does not ensure full coverage. Many a times, people don’t get full coverage of air ambulance flights even if they are alive owing to the nature of care plans.
It must be noted that Medicare coverage of air ambulance flights is very limited. You should further discuss the issue of coverage with your flight coordinator to get a clearer picture beforehand.