The phenomenon, widely known as surprise billing, has troubled the United States for quite some time. It has been highlighted from time to time and fingers have been pointed at the insurance companies. The air ambulance industry is the only exception where it is being blamed for the excess bills that people are compelled to foot. Why so? The answer is obvious: the size of the bills is so big that it often makes headlines. In this context, the pertinent question to ask is this: is surprise billing a problem that is limited to the air ambulance industry? The answer is a resounding ‘no’.
Air Ambulance Services and the Concept of Insurance Network
Imagine a situation where you have to get checked for a potential disease that can be life-threatening. You take care to ensure that you choose a hospital that is within your insurance network. You are referred to a specialist and a few lab tests are ordered. A week later, you come to know that the specialist and the lab tests are not within the insurance network and you are expected to pay off the bills all by yourself. It seems like a no-win situation, right?
Whose Responsibility is to Verify Insurance Network?
It is unrealistic to expect the patients, who often are in emergencies, to verify network coverage before availing treatment. The responsibility must, therefore, be jointly shared by the service providers and the insurance companies. At present, that is not the case. This is the precise reason why surprise billing is so prevalent. In the case of air ambulance services, this amount is usually pretty steep, driving families towards bankruptcy. The blame ultimately is pinned on the air ambulance industry, which is not entirely fair. However, it must be noted that the medical flight industry is loosely regulated when it comes to billing practices and must be scrutinized too.
People around the world are wary of getting out of the confines of the home due to the COVID-19 pandemic. The result has been a reduction in emergency calls for the air ambulance industry. The change has come into play due to the reduced crime rates and accidents as fewer people have ventured out lately. While this is a good sign in general, there is a negative commercial aspect to it that can affect this commercial emergency service profoundly. It must be understood that reduced calls affect the revenue of the air ambulance industry in general where most players are heavily indebted.
The Expenses have Increased
Responding to emergencies is no longer the same as it used to be. The COVID-19 pandemic has changed things deeply. Today, the paramedics must sport personal protective equipment (PPE) before they venture out into helping anyone on the ground. This is essential to protect the crew’s health and also that of the person who is facing the emergency. This results in a further uptick in the cost as these PPEs cannot be reused. Also, there are protocols in place for sanitization after each evacuation, which further adds to the cost.
The Air Ambulance Industry is Seeking Financial Aid
It is not that there has been no financial aid coming towards the air ambulance industry; however, it is yet to be seen how effective the distribution has been. It must be noted in this context that several small players in the industry cater to rural communities. These critical services are the only line of defense for these communities where local hospitals have shut down in large numbers. If these organizations are not helped financially, they might eventually shut down. It is therefore vital that a close watch is kept on the industry’s requirements.
The lockdowns around the world are easing, down and people are slowly gaining the confidence back to venture out and involve in matters that are pressing for a society to function normally. One of such activities is medical flight charity. Countries like the United Kingdom depend heavily on public contributions to keep the air ambulance services running. Here are a few developments that stand evidence to the fact that they are inching towards normalcy.
A Kid from Reading Raising Money for Medical Flight Services
Alfie, an 8-year-old boy, has made news for his efforts to raise money for Children’s Air Ambulance. This enterprising child organized a sponsored run and has been selling bird feeders to raise money. It is believed that he has already raised a few hundred pounds through his relentless efforts. Alfie is a part of #TheCrew, a children’s club, involved in raising money for the worthy cause.
Medics in Ireland take up Cycling Challenge to Raise Money
A team of 11, comprising of an engineer, six doctors, and 4 paramedics is all set to take up a cycling challenge that will cover 110 miles. The effort has come in the face of COVID-19 pandemic, which stalled several fund-raising efforts. The endurance challenge is set to take place between the 2nd and 3rd of October. The expectation is that it will raise the much-needed funds to keep the medical flight services going. They are doing this for the Northern Ireland Air Ambulance.
Midlands Air Ambulance Charity goes Virtual
This charity has revealed that their pre-hospital services have shot up by 35% due to the COVID-19 pandemic. The organization has, therefore, decided to give the community that it serves an insight into what typically goes on. It will, of course, be a fund-raising initiative too. The organization has taken the virtual route to ensure the safety of the community amid the pandemic.
Congress has been focussing heavily on eliminating surprise billing practices and involves not just the air ambulance industry but the healthcare landscape as a whole in the United States. In this regard, one significant development has been the introduction of the Consumer Protection Against Surprise Medical Billing Act. The Act is currently slated to enter the United States House of Representatives for a vote. Thus far, the billing practices of the industry have found protection under the Airline Deregulation Act of 1978, which precludes the states from interfering in the matters of medical flight billing.
The New Bill and Air Ambulance Billing
The most important provision of the bill is that it will protect all the patients against balance billing practices even if the service provider is out-of-network of the insurance company. The patients will only be charged according to the in-network charges, which obviously will be covered by their insurance.
Explanation of benefits in advance is another important provision. Currently, the patients have no say in opting for air ambulance services during emergencies. The healthcare provider would take the call during the emergency, and the patient would not have a say. This will change with the introduction of the new bill, allowing the patient to make an informed decision.
If the new bill is successful, the air ambulance service providers would be compelled to give cost estimates before providing the services to the patient. In essence, the patient will be able to make a prudent financial decision if he or she is paying by cash or is uninsured.
A mediated process for resolution of the dispute would be put in place. Any party involved including the air ambulance company would be free to dispute any part of the payment through a mediated process. There would be a window of 30 days to find a resolution.
An insurer has gone to the Kansas Supreme Court dragging a medical flight company. The contention has been that the company has been charging unreasonably high prices for its services. Terming the practice of billing ‘predatory’, the petitioner has asked the court to intervene, although the medical flight industry has been insulated by a federal law that bars states from interfering in the matters of billing. The court is yet to pass a ruling, and the service provider in question is EagleMed. The air ambulance industry argues that high charges towards privately insured people are a way to offset the losses resulting from uninsured people or those with Medicaid and Medicare.
The Tough Competition in the Medical Flight Industry
There are several players in the medical flight industry today. This means more service providers for a limited number of service seekers. This makes it incredibly hard for most companies to stay afloat because they fail to get enough customers to balance the costs. As a result, the cost of maintenance is distributed among those who avail of their services. The federal law acts as a shield allowing these companies to employ this practice.
The Federal Law is Aimed at Staying Competitive
The Airline Deregulation Act of 1978 is a federal law. It is aimed at airlines, and since the medical flight industry is considered a part of aviation and not the healthcare industry, the Act holds good for it too. However, the main purpose of this act is to encourage competition to lower prices. This is not the case with air ambulances. Since the patients have little say in the service providers that they choose during emergencies, the medical flight companies get a free hand to charge as they please. The insurance companies, on the other hand, have not changed their coverage for years together. This translates into lower coverage, and the ultimate burden of clearing the bills falls on the customers.
In January 2019, a deadly air ambulance crash had killed the entire crew. The cause of the crash was harsh weather conditions. It has now been reported that the crash was due to lax safety procedures in place. The service provider in question is Survival Flight. The report comes from the federal investigators who have been looking into the cause of the air ambulance crash. The National Transportation Safety Board has alleged that the company had inadequately managed safety. Moreover, the service provider had not conducted adequate risk analysis before taking up the flight.
The Air Ambulance had Crashed in South Eastern Ohio
It is believed that, at least, two air ambulance service providers had refused to carry the patient who was in an emergency health condition. The cause was poor weather conditions marked by heavy snowing and consequent poor visibility. It is believed that the inclement weather condition was the primary reason for the crash. The medical flight had crashed into the heavily wooded hillside and had broken into several pieces. The pilot Jennifer Topper and crew members Rachel Cunningham and Bradley Haynes were instantly killed. They were 34, 33, and 48 years old respectively.
Was the Flight Undertaken by Flouting Rules?
It must be understood that it is not illegal to fly an air ambulance when it is snowing lightly; however, it is not authorized to fly when the visibility is poor due to heavy snowing, which inhibits the pilot from having a clear view of the ground. Besides, there is a risk of air ambulance freezing. It is believed that, in this case, the poor visibility had led the pilot to undertake some abrupt maneuvers and had resulted in the crash. The incident stands evidence to the fact that some service providers flout the rules in the interest of either helping the patients or making the ends meet.
The adoption of private equity is not just a predicament for the air ambulance industry but the entire healthcare system in the United States. Several financial institutions in the country have shown a keen interest in healthcare in recent times. There is no doubt that it makes the whole sector highly competitive with ready access to funds. However, what bothers most people is the profit motive of private equities. The healthcare and air ambulance industries being more human-centric, it does not seem right to most people that they are viewed as a source of profit. They opine that healthcare must be a pure welfare activity.
What’s the Air Ambulance Industry Got to Lose?
Many people believe that the high prices charged by air ambulance companies are directly a result of heavy private equity investment in them. Investors simply do not want to make any losses, even though the United States is flooded with several air medical transport companies, so much so that the consumer base is starting to look too small. This is causing more idle time for many companies. As a result, their costs are piling up and are being ultimately transferred to the customer.
Will the COVID-19 Pandemic Transform the Industry?
The COVID-19 pandemic has drastically cut down the demand for air ambulance services. The reason behind this is simple. The industry relies heavily on helicopters, which are not built to handle highly infectious diseases like COVID-19. The pandemic has given no adaption time to the air ambulance service providers. The lack of isolation between the crew and the infected patients, in addition to the sanitization needs, has made air medical transport not the best option, at least locally. However, they are still being utilized for international evacuations, although not large in numbers.
Experts opine that, if the prevailing low-demand situation persists, there are going to be several service providers who will be forced to shut down, creating a balance between the number of players in the market and the size of the market.
In the past, the air ambulance industry has proved that it is an indispensable part of the health emergency services in the United States and beyond. The cost of availing the services has been a concern, but that apart, the utility of the air ambulance industry has never been questioned. Today, it plays an important role in repatriating COVID-19 patients from beyond the borders. It is also continuing to play a huge role in offering quality care to people in the rural parts of the United States. However, because of the COVID-19 situation, there needs to be a change in the way this industry functions.
Definition of Medical Necessity has Changed in the Air Ambulance Industry
Of course, we are not referring to medical necessity in the context of insurance coverage, approvals, etc. That remains the same. However, today, hospitals are encouraging people not to visit them unless it is important. The reason behind this is simple; people who already have a serious health condition must refrain from visiting spots that are hotbeds of COVID-19 infections, hospitals being one among these. The air ambulance industry is not completely prepared to handle this pandemic that is of epic proportions.
Recommending Air Ambulance Services Demands Careful Deliberation Today
Most of the helicopters in the air ambulance industry are not isolated enough to separate the patient from the rest of the crew. This poses a threat both to the healthcare workers and the patients. The problem of isolation does not exist in ground ambulances.
Besides, reaching the hospital early does not translate into immediate admissions today. Depending on the symptoms of the patient, he or she might need to be tested and isolated before being treated. The treatment protocols are still evolving. In essence, the physicians recommending air ambulance services should do so only after careful deliberation.
The COVID-19 pandemic is slowly making inroads into rural America. The higher number of elderly people living in rural communities is especially vulnerable now. Moreover, the infection is known to be fatal to people with diabetes, heart disease, and other ailments that impact natural immunity in human beings. All things considered, people living in rural parts of the country must have access to medical flights. However, this is turning out to be a huge problem for organizations that offer air ambulance services. It has again boiled down to balance billing, insurance denials, and financial burden to patients.
Medical Flights Being Denied Coverage is a Concern
Medical flights are a part of an industry that is highly competitive and which is already struggling to stay afloat. The COVID-19 situation has created an emergency of sorts throughout the nation and medical flights need to play a huge role in offering adequate coverage to rural communities. However, the threat of inadequate coverage is limiting its services. In this context, it must be noted that when coverage is denied by insurance companies, the burden is shifted to the patients. This presents a significant financial burden to the patients that can run into several tens of thousands.
The Percentage of Balance Billing is Small but Significant
About 300,000 air ambulance evacuations are carried out every year; of this, 3% end up in balance bills. This is primarily due to insurance denials. Most of these denials are due to the service provider being out-of-network.
The providers of medical flights too have not been keen on going in-network with insurance companies. The reason for this is the fact that reimbursements rates have remained unchanged. However, there is hope. With states like Florida looking to revise insurance reimbursement rates, the scenario could change soon.
Previously, the only use that was being seen for medical flight services amidst the COVID-19 pandemic was the transportation of infected patients from rural America. The reasoning behind this was that the urban part of the nation is better equipped to provide healthcare. However, it was later seen that the rural spread was quite limited. Unfortunately, recent trends have been quite different. While global cities such as New York continue to grapple with the disease, the infection is now seen making way towards inner parts of the nation, especially the rural regions. The reason for this could be several, including people from cities finding save havens in isolated rural regions.
Chronically Ill will Need Medical Flight Services
The Novel Coronavirus is known to increase the risk of people with co-morbidities, especially if they are over 60 years of age. It must be noted in this context that most of the rural population in the United States is old and is at high risk of losing lives if faced by a COVID-19 attack. Imagine someone suffering from cancer and also contracting the disease. The only recourse would be to take the patient to the nearest appropriate treating facility in the shortest possible time. That would, undoubtedly, necessitate medical flight services.
An Industry Struggling to Stay Afloat
The medical flight industry has been at the forefront of evacuating American citizens who are stuck in countries hit by COVID-19. However, it is worth noting here that the industry, which was already struggling to survive due to high costs, has had it even worse amid the pandemic. The demand for services has fallen drastically. Moreover, personal protective equipment has been hard to procure. The biggest hurdle has been the lack of frontline workers as most of them are now fighting the virus on the ground.