The No Surprises Act has got everyone talking these days. From the word go, there has been a feeling in the air ambulance industry that the regulation is going to go against it. Now, industry experts believe that the fear is turning into a reality.
The intent of the No Surprises Act is excellent. In that, it plans to exclude the patient from the picture when a payment dispute arises. In other words, when an insurance company refuses to cover the air ambulance cost in full, the burden of balance payments does not fall on the patient. It is for the insurance company and the air ambulance service provider to settle the financial differences between themselves.
The Air Ambulance Association Cites Problem with IDR
IDR stands for independent dispute resolution. It has been drafted such that insurance providers and healthcare providers (including air ambulance service providers) can hold discussions between themselves and come to a conclusion on payments. If not, they are free to approach an independent entity as defined by the No Surprises Act. However, one of the clauses set by Congress says that no single statutory factor must veer in any direction during IDR. However, the air ambulance association felt that the federal government was weighing heavily on a single factor and that is qualified payment amount or QPA.
The air ambulance association is of the opinion that the impetus solely on QPA will have disastrous consequences for the industry and also the people that it caters to. If the insurance providers are the sole authority on the payments that are to be made for medical flight services, it may prove detrimental to the industry. Ultimately, it will act as a disincentive to the air ambulance business. Many air ambulance service providers may be forced to shut their businesses.
Let’s face it – going on vacation amid the global pandemic is not the same as it used to be. Access to medical flights is an absolute necessity. While some parts of the world have completely shut themselves down to the outside public, others have taken a cautious approach. Added to this is the fact that more variants are constantly popping up in several parts of the world. Tests to ensure infection-free passengers have become a norm today. All these things have made it tough for emergency medical flights to function without any hurdles.
Medical Flights and Insurance
The importance of travel insurance is very high in the current scenario. For instance, you go on a vacation to Bali. You arrive in the country without any symptoms, enjoy yourself, and are about to get back to your home country. The travel, of course, will require you to produce a COVID-negative medical report. What if you find out that you are positive, and over the ensuing days, find yourself battling against the symptoms of COVID infection? Would you not want to be close to your family when an instance like this occurs? It becomes virtually impossible to travel to your country given the huge costs involved in hiring medical flights across borders. This is when insurance comes into the picture.
Looking Beyond Evacuations
The symptoms that you experience may not warrant medical flights but what about staying in the country that you are visiting. If you are on a budget, things can get a little tricky and travel insurance can help. You might need to quarantine yourself in a designated facility. Of course, if the symptoms are severe, you might even need an air ambulance to get to the nearest treatment facility, which can sometimes mean taking adequate permissions and flying back to your country. All this becomes an uphill task when you do not have the right travel insurance and access to medical flights.
Insurance coverage denials have long troubled patients, especially when they avail of air ambulance services based on the suggestions of treating physicians. It must be noted that any patient who is in a serious medical condition cannot deny air ambulance transport surpassing the suggestion by the treating physician. The situation has caused many instances where the cost burden is ultimately transferred to the patient when the insurance company denies coverage. This time around, it was a patient who was suggested to fly to a level 1 trauma hospital in Florida. He was on a cruise at the time, and he had suffered a myocardial infarction.
The Insurance Company Had Suggested Against Using Air Ambulance Service
Insurance companies usually suggest that patients are brought to the nearest appropriate treating facility, else the coverage is denied. However, it is the insurance company that decides the appropriateness of the treating facility. In this case, the treating physician had suggested a facility in Florida whereas the insurance company had suggested a nearby hospital. Despite what the insurance provider had said, the patient was flown to Florida. This was the reason why his insurance coverage was denied. In response to this, the patient has now sued the insurance company.
The Air Ambulance Bill Came up to USD 240,000
An air ambulance bill that runs into huge amounts, such as the one received by the patient in question, can run anyone into bankruptcy. The reason cited for denial was that the advice of the insurance provider was not heeded. The hospital expenses and the land ambulance cost were covered but not the air ambulance service.
The lawsuit was filed on the 6th of October by the patient and names the insurance company for denying the coverage. He believes that the insurance provider had wrongly tried to force him to avail of a medical facility that was not in his best interest.
It was not too long ago that news headlines were abuzz with the possibility of ending surprise billing but now, it seems nothing much has changed. The air ambulance industry too was watching the development with much anticipation. What happened to all the efforts surrounding it? If this question has across your mind, you are not alone. Thousands of Americans were hoping that the practice ends, and they can avail healthcare facilities without worrying about insurance coverage. Had the bill been passed, people would have enjoyed seamless coverage despite being in or out of insurance networks. However, this does not seem to be the case anymore. Let’s take a look at what happened.
Are Private Equity Investors to Be Blamed?
There are allegations flying around that big investors ran an aggressive ad campaign to cast doubts on the move to ban surprise billing practices. On the part of the air ambulance industry, it must be noted that several service providers had enrolled themselves with various insurance providers to widen their network – a very welcome move.
Another set of people believe that lobbying against the bill was quite strong. In that, some of the lawmakers, at the end of it, were not very keen on ending the practice. The reason behind this is not entirely clear, though.
Is COVID-119 to be Blamed?
Many industries, including the air ambulance industry, had felt the effects of the COVID-19 pandemic that gripped the world. The increase in cost – owing to extensive sanitization and pandemic protocols – and reduction in demand were just a few of the reasons that put economic pressure on the air ambulance industry. Besides, the availability of medical staff became a big concern. The government too was grappling with ways to combat the unprecedented situation. With so many things weighing in, the will to do away with surprise billing seems to have simply vanished – at least for the time being.
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.
Healthcare costs are not just about air ambulance costs. The United States of America has one of the highest healthcare costs in the entire world. An average American spends over 10 thousand USD in a year and the nation spends 3.3 trillion USD each year. This amounts to about 18 percent of the country’s GDP. Let alone the need for an air ambulance, a simple emergency room visit can leave a foreign national in huge debt. Hospitals simply do not release patients unless the care debts are paid out in full. A scenario like this can quickly turn a fun vacation into a financial nightmare, leaving the patient bankrupt.
A New Legislation May Necessitate Insurance
Although the legislation is primarily targeted towards immigrants to the nation, it is not entirely clear whether it applies to visitors to the nation as well. According to the new law, immigrants will have to purchase insurance for a period of 365 days or until such time that they stay in the country, whichever comes earlier. The move is meant to insulate the country from bearing high healthcare costs. In the face of this uncertainty, experts recommend that, regardless of the regulation, visitors must opt for comprehensive insurance.
A Policy that Covers Air Ambulance Services is Ideal
Not all visitors to the country arrive without insurance. However, many of them do not opt for adequate coverage. A slightly expensive premium can offer comprehensive coverage. Here is a scenario: you embark on a cruise during your visit. Unfortunately, you end up having a stroke. You will need to be flown to the nearest appropriate medical facility via an air ambulance service. The cost of this transport is going to cost quite a lot. The wise thing to do, therefore, is to explicitly ask your insurance provider about air ambulance coverage to stay safe.
There’s a lot happening in the air medical transport industry currently. With the state lawmakers and the feds trying hard to end surprise air medical billing practices, there is a high degree of lobbying that is taking place both by insurance and air medical transport industry. There is a huge amount of blame game going on. Both parties are trying to pin the blame on each other. Often, you’ll find articles that highlight high bills that patients are compelled to foot and on the other hand, articles that detail the plight of the air ambulance industry and the rising costs it is grappling with.
What is a Surprise Air Medical Transport Bill?
In order to understand what surprise air medical transport bill is, we should adopt an industry agnostic perspective. The problem is not just with the air ambulance industry, it is rampant throughout the medical world. In the United States, unlike other parts of the world, insurance is a matter of network coverage. If a provider is not covered by the insurance company, it is likely that the reimbursement is going to be rejected. This compels the patients to foot the bill all by themselves. This phenomenon, where a person is compelled to pay a medical bill, in spite of having medical insurance, is known as surprise bill. This is what the polity of the nation is currently trying to eliminate.
Why is Tough to Eliminate Surprise Billing?
There are several facets to this. Some air ambulance companies, in the absence of fair reimbursement by insurance industry, simply do not want to come in network. The question arises, “Why?” The answer is obvious – this move paves the way for balance billing where the patient becomes responsible to foot that cost which is not covered by the insurance provider. Then who is to blame? Well, both insurance and air ambulance industries: the insurance industry because it refuses to reimburse a fair amount and the air medical transport industry because it refuses to come within insurance networks. It’s a Catch-22 situation.
Travel insurance is the safety net that you need when travelling abroad, especially in countries where the quality of health care is not the same as the one you enjoy in your home country. In such situations, air ambulance can become an absolute necessity. Most people assume that travel insurances automatically ensure an air ambulance to their home countries if they felt there is a necessity and that it is the patients’ choice to get the treatment wherever they desire; however, these beliefs are far from true. The insurance company can actually deny a claim and for the patient to get treatment in the visiting country. The company would weigh the cost advantage in situations like these.
Checks Air Ambulance Cover Before Purchasing the Travel Insurance
Explore as many travel insurance options as you can before zeroing down on a specific one. Reveal upfront the kind of activities you plan to indulge in and check out the premiums. If you have any pre-existing illness, make that known clearly and check out the premiums. The fear of higher premiums must not deter you from making this revelation as you can get into a huge financial mess owing to this mistake later.
Know Your Coverage Well
Also, some activities are considered very high risk and certain travel insurance policies might not cover them. If you’re going to be a part of some extreme adventure event, check out the facilities that the organizers offer and also whether the insurance company is willing to cover the mishaps that occur during such activities.
There have been several instances in the recent past where the travelers have not bothered to look closely enough whether the insurance company covers air ambulance services and later have had to resort to crowd funding to afford international air ambulance services. A little homework can avoid such issues and make your travel more secure and safe.
‘Stringent’ is the word that comes to mind when you think of medical flight insurance coverage norms. Cost reimbursements of medical flights can mean between a retaining your life savings and letting it go to cover the huge bills. It is important to know the basis on which insurance companies accept or deny the claims. Of course, the foremost thing is to own a health insurance policy that covers medical flight services or medical transportation of any form for that matter. If this condition is taken care of, following are the other conditions that you must be mindful of.
Insurance Coverage for Medical Flight Services
Medical flight services to and from hospitals are covered by Medicare Part B. It is worthy to note here that air medical transportation to skilled nursing facilities is also covered under Part B. However, it should be noted that medical flight coverage is provided when it is deemed that ground ambulances are not suitable for the medical condition or when it is determined that the patient is in dire need of care and timely care is possible when the patient is carried to the treating facility in the shortest possible time via an air ambulance.
Approval by the Treating Professional is Necessary
The ultimate decision of whether a medical flight service is necessary lies with the treating professional who could be a physician or a paramedic attending an emergency. This decision cannot be taken by the patient and in most cases cannot be overruled either.
If the medical flight company feels that the patient might not be able to pay for its services, it can ask the patient to sign Advance Beneficiary Notice that states that the patient would be responsible for the payment in case the insurance company refuses reimbursement. The patient can refuse to sign this notice; however, if the air ambulance company goes ahead and carries the patient, he or she might still be held responsible for the payment.
Americans today seem to have a false sense of security thinking that everything related to their medical wellbeing is automatically covered by health insurance. The reality is far from this belief. The health insurance providers differentiate between hospital expenses and medical air transport. While a good insurance will cover almost the entire medical treatment bill, the same insurance would hardly cover one-third of the medical air transport bill. To make matters worse, the medical air transport cost, even for short distances, sometimes is very high.
Why are Medical Air Transport Costs so High?
Maintaining helicopters and airplanes is no child’s play. It’s an expensive affair. Plus, keeping emergency professionals on standby at all times means additional costs. All these expenses, of course, have to be ultimately borne by the patients availing the services or the health insurance providers. The insurance providers only cover the in-network medical air transport services, and since insurance companies tend to disagree with the high bills that air ambulance companies generate, they only end up covering a part of it. This dissuades these companies to go in-network with the insurance carriers.
There is a Way Out and It Does not Cost Much
All it takes is a bit of planning. When you know well that insurance companies do not cover the expenses fully, exploring other options is the wise thing to do. There are several agencies that specialize in providing medical transport coverage. The costs are nominal and the coverage is usually good. They cover those expenses which are left uncovered by the insurance companies. So, in today’s world while ensuring medical insurance coverage is important, it is equally important to also keep yourself and your family covered for medical air transport emergencies. Failing to do so, can land you in a financial mess that can take years to clean up.