The air ambulance industry, for the most part, had been opposed to the recently passed bill by Congress that seeks to put an end to surprise billing practices. The state governments in the United States have been on a long and hard-fought quest to curb surprise billing practices. However, since the air ambulance industry is protected by federal law, states were helpless in controlling their billing practices. This fact has now changed and brought along new challenges for the air ambulance industry. Most of the players in the medical flight industry are private-equity based and have largely remained out of insurance networks. The new bill can hit them hard.
Effect on the Air Ambulance Industry
Maintaining air ambulance services is no small task. From maintaining the aircraft and hangars to paying off highly experienced and qualified personnel, the costs are high. So far, the costs were covered well as the discretion to bill their services had no curbs. Now, with the new bill, the air ambulance companies will have to make do with what the insurance companies approve. Failing to agree on the pricing will only lead them to an arbitrator whose decision will be final.
What Can the Air Ambulance Industry do?
It goes without saying that profits will dwindle down. However, as most air ambulance companies have already begun doing, it makes sense to join insurance networks. This will ease the payment process. Also, it is time that the industry looks at quality services wherein patients voluntarily opt for their services, even if it means that they will need to pay an out-of-pocket premium. The air ambulance industry now needs to veer its attention towards brand building activities. In this context, it must be noted that the service providers are still not compelled to limit their bills. The only change is that patients will no longer be liable to pay balance bills unless they opt to do so.
A bill concerning the surprise billing practices of the medical flight industry might bring a solution soon. The insurance companies and the medical flight industry have been in the midst of a heavily fought battle around this. Both parties have time and again blamed each other for the high air ambulance bills that patients receive. Such developments have also resulted in bad press for both the players. However, bringing the air ambulance industry to compromise on its billing practices has so far seemed impossible. This is mainly because the states have little control over them and the Federal Government has been sitting over it for quite some time.
The COVID-19 Situation and the Medical Flight Bill
The COVID-19 pandemic had definitely delayed the passage of any bill related to surprise billing practices of the medical flight industry. However, it now seems that it may be passed along with the COVID-19 relief bill. Politicians have intervened to get both parties to find a middle ground, but it has largely been unsuccessful. Both the industries have not budged from their stand but it must be noted that most medical flight service providers have tried to get into insurance networks in recent times.
What Will the Bill Do?
The Federal bill will prohibit medical flight service providers from charging the patients directly for their services in the event that they are out of the patient’s insurance network. This is mainly being done as any patient, during critical times, has no time to contemplate the choices. On the question as to what would happen when a patient wilfully chooses an out-of-network medical flight, he or she might have to pay out of pocket, but there are restrictions. The medical flight service provider can only charge the patient if the patient is given 72 hours to analyze the costs. The patient’s consent to use the services in such instances is also important. If the bill goes through, it could change the landscape of the medical flight industry.
Medical flight maintenance is a systematic process and is guided by the industry best practices and rules that govern the air ambulance industry itself. Then, there is a multitude of aircraft models that demand the maintenance of different degrees. The main difference is rotor-wing and fixed-wing medical flight vehicles. The rotor-wing medical flight services are usually deployed in hard-to-reach situations like rescuing a stranded adventure seeker or a victim of a motor vehicle accident on the highways. The fixed-wing medical flight services, on the other hand, come in handy in long haul flights were the patients need to be carried for hundreds or even a thousand miles. Most medical flight companies maintain a mix of both.
Each Medical Flight Demands a Different Kind of Maintenance
Bell, Airbus, Hawker Jets, King Airs, Cessnas, Lear Jets – the list of aircraft that medical flight service providers maintain is quite huge and each comes with a different need. On top of that, there is a myriad of medical equipment that goes into each of these medical flights such as ventilators, intravenous fluid infusion equipment, ventilators, oxygen cylinders, defibrillators, and many more. Added to this is the decontamination and sanitization protocol over the existing ones due to the COVID-19 pandemic. All this translates to a huge amount of maintenance.
Allied Maintenance is Also a Factor
The hangars, training, and accreditations are just a few of the allied maintenances that come along with medical flight services. Each aspect demands specialized skills. In addition, emergency professionals need to be trained on an ongoing basis to keep up with the latest development in the industry.
All these aspects lead to better care and improved outcomes; however, they come at a cost. This is one of the reasons why medical flight charges are pretty steep, and without insurance, affording such care can be quite difficult.
We have, for long, maintained that the air ambulance industry is extremely vital for the rural communities spread across the length and breadth of the United States. Now, with the flu season right around the corner, the importance of medical flights is even more. Besides, it looks like the COVID-19 pandemic is making a comeback with an increasing number of cases being reported throughout the country. There is no doubt that the population in the rural communities of the country will need special care in the days to come and the air ambulance industry will be the focus.
Air Ambulance Industry is the Bridge Rural America Needs
The onset of flu season may result in a flood of patients surging towards rural hospitals. The problem, however, is that there are not many health care facilities in these areas. Also, the capacity of these facilities to handle the pandemic could be less adequate than what the situation demands. Just think of the demands that a situation like this can place on the already stretched medical staff and resources. The situation can quickly turn chaotic and ultimately, lead to unprecedented tragedies. The time is right to pave way for the air ambulance industry to remain on standby.
How Can the Industry Prepare?
There are two aspects to this question. The first is under the control of the air ambulance industry. This includes setting up isolation pods, keeping resources such as PPEs handy, training the medical staff, etc. In fact, much of the air ambulance industry is already prepared due to the previous surge in COVID-19 cases.
The second part, however, is completely out of the air ambulance industry’s control. It involves money. With the insurance companies continuing to deny coverage for much of what the air ambulance companies quote, the problem is sure to bite the raw wound again.
Sounds a little odd that medical flights are a part of F1 racing, right? Not when you look at it closely. The safety rules surrounding F1 necessitate that any injured driver receives treatment within 20 minutes. However, it is impossible to get treatment at that speed without the involvement of medical flights. In fact, air ambulances are always on standby during the races. Not just that, they are kept ready even during practice sessions. Any time the medical flights are not able to function due to one reason or the other, the race itself is canceled. Such is the importance attached to the availability of quick reach to treatment and air ambulances are a big part of it.
The Recent Unavailability of Medical Flights during Practice Sessions
The practice session was recently canceled at the Nurburgring track. The reason was the inability of medical flights to function due to adverse weather conditions. The track is prone to thick fog during certain times of the year, and this is an obstacle to operate air ambulances. Recently, two practice sessions were abandoned due to this reason. The fans that were there to watch their favorite sports stars were in for a disappointment.
Change in Protocols to Maintain Safety
The third session of the F1 practice session was held with a few changes in the protocol without compromising safety. Land ambulances were kept handy in case of emergencies. They would transport the injured to a certain distance where an air ambulance would be stationed and ready to go to the nearest appropriate facility. The medical flight was parked in a location where the weather conditions were congenial. The entire protocol was designed such that the evacuation would still be possible within 20 minutes. Of course, if the weather clears up, there would not be a need for the new protocol at all.
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.
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 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.