Frequent travelers – especially those who go to various countries for business – usually make sure that they have an emergency air ambulance evacuation membership. These memberships are in addition to the travel insurance coverage that is usually bought.
Today, COVID-19 has thrown up new problems when it comes to evacuation utilizing air ambulance services across borders. The million-dollar question, therefore, is this – “are air ambulance evacuation memberships useless in the current scenario?”
International Air Ambulance Evacuation Memberships are Currently of No Use
One thing that most countries have in common during this COVID-19 pandemic is the lockdown. Almost all countries have locked their borders to international flights. No one can get in or out of a country any longer unless it is a rescue mission that is conducted by the governments at the highest diplomatic levels. What use is an air ambulance evacuation membership in this scenario? The answer to this question is obvious. There is no much that a medical flight company can do in a situation like this. However, the efficacy of this emergency transport remains for domestic transfers. They are all the more important in the face of the Coronavirus epidemic that has gripped the United States today.
Air Ambulance Membership and Domestic Emergency Evacuation
The United States is preparing to face the pandemic on a war footing. However, the risk of spread to the rural areas still looms large. If there is an outbreak in the rural areas, air ambulance memberships are going to come quite handy. Reaching the urban medical facilities on time will be crucial for those who are severely infected by Coronavirus.
In this context, people must note that it is only the most severe of the cases that are admitted to hospitals for critical care and ventilator support. However, most of the infections are mild, and experts say that some are even asymptomatic.
As the United States comes to a realization that its healthcare system – one of the most expensive in the world – is not all that prepared to handle the Coronavirus or COVID-119 pandemic, medical flights are turning out to be the most viable option, especially for rural communities of the country. According to one estimate by Kaiser Health News, there are over 7 million people in the United States who are 60-plus and at a particularly high risk of severe Coronavirus infection. Now, add to the mix, the fact that over half of the counties in the country do not have enough intensive care beds and the magnitude of the problem suddenly dawns upon us.
Reaching Intensive Care Units via Medical Flights
Intensive care units usually have high-tech bedside equipment that is, otherwise, absent in regular healthcare facilities. They have ventilators that are essential for survival in severe COVID-19 cases. In this context, it must be noted that in most counties, where intensive care units are available, the number of beds is hugely limited. At times, it is just one bed for a few hundred seniors. For instance, it has been highlighted that in Jefferson County, the Louisville area has just one intensive care unit bed for almost 450 people. If you thought that was bad, imagine the state of Santa Cruz, California, which just has one for over 2,500 people. However, the numbers improve significantly when it comes to urban areas. This gap can be efficiently bridged by medical flights.
Costs, Insurance, and Medical Flights
In the days to come, it is the will of the government that will matter the most. If drastic steps are taken to take care of the cost of medical flights through better insurance coverage or government aid, the situation can be handled better. At the current time, a clear indication needs to go out to the providers of medical flights, so that they can prep their choppers and airplanes to aid in the containment of the pandemic in a timely manner.
Surprise billing or balance billing is not just a problem specific to the air ambulance industry. The healthcare landscape itself is riddled with it. We have seen far too often that people who opt for a medical flight service receive huge bills that are not covered by the insurance network.
As a result, they end up liable to pay the surprise bill to the air ambulance service provider. While we often see that the money is waved off or a huge discount is offered, it is still an inconvenience and often a point of friction between the consumers and the medical flight company.
Is the Air Ambulance Industry Doing Enough?
Doubts are often raised whether the air ambulance industry is doing enough to keep the costs in check. While it is undeniable that there are some bad actors, the industry experts reveal that going in-network is not an option. The reason is the unfair reimbursement rates they say.
At the current time, the cost projections by the air ambulance industry and what the insurance companies are willing to reimburse are poles apart. Of course, there are some initiatives like memberships that medical flight companies offer, but not many are able to get the full benefits of such initiatives as consumers do not feel that necessity to pay extra, in addition to their insurance premiums.
What Can the Air Ambulance Industry Do Further?
It all comes down to negotiations. It is imperative that the air ambulance industry has a healthy discussion with the insurance companies to arrive at a fair reimbursement rates. The industry must be flexible enough to ultimately join the insurance networks.
Moreover, there is a necessity to present their points of view to the government so that there is a clear understanding of the roadblocks. The ultimate aim must be to unburden the common man.
The United States is a country that takes pride in its capitalistic foundations and private equity is a big part of it. Making America great are the enterprising individuals who have found new business avenues and turned their fortunes. In this context, one questions whether the same outlook must be adopted towards the air ambulance industry. Today, the industry is mostly run by firms that leverage private equity to keep floating. However, that comes as no surprise. The medical flight industry is one that sees high demand. It is natural that businessmen want to invest in it.
Air Ambulance Industry and Rising Costs
While the country has not seen high inflation, air ambulance industry has witnessed a steep rise in its costs – thanks to the ever-evolving safety measures and cost a good deal. In addition, there is the need to keep the staff well trained to tackle new equipments. On top of all that, maintaining high standards is not enough, accreditations that stand as evidence to the quality is essential, which again is a cost. Factors such as these are pushing the prices of medical flight services quite high today, to the extent that – without insurance coverage – they are almost impossible to afford.
Prevalence of Too Many Players in the Air Ambulance Industry
The air ambulance industry today witnesses several new entrants. The existing ones too are expanding at a tremendous pace. All this could be leading to an oversupply. However, oversupply is a two-edged sword. It increases the cost that ‘idle time’ attracts. In turn, this pushes the cost of each unit (read cost of each flight) higher as each unit now has to cover higher costs. This could be compelling the air ambulance industry to charge its customers high prices, something that the insurance industry has not been willing to foot lately.
The expectation is that the oversupply balances itself out eventually as the unprofitable ventures close down, and ultimately, a perfect market condition prevails.
Well this might not come to you as a surprise because you might have witnessed this yourself. According to one survey conducted by Kaiser Family Foundation, about 40% of US citizens have revealed that their families have received a medical bill despite being covered by medical insurance. This is a growing problem for the country as insurance companies are seen restricting the number of providers in their networks. Of course, out of network providers are not covered by insurance companies. In this context, the question arises, is it the same logic behind huge medical flight bills that people across the country are witnessing?
Medical Flight Bills and Insurance Network
A majority of industry experts believe medical flight service providers willingly stay out of insurance networks. The reason is simple, they lose the freedom to charge what they feel is fair for their services. It is also felt that there is a huge disparity between what the medical flight industry believes is a fair payout and what the insurance industry pays. The middle ground, it seems, is something that has not been achieved so far. The issue has not gone unnoticed by the lawmakers. However, the opinion is divided as to who is responsible for the huge bills.
Efforts by Lawmakers to Bring Down the Bills
Several attempts have been made to limit the amount that can be charged for medical flight services. From trying to ban balance billing to compelling air ambulance companies to come under insurance networks, several innovative efforts have failed. The reason behind this is the Airline Deregulation Act of 1978. Designed to create a competitive environment to keep the price of this essential service down, it precludes the state governments from intervening in the matters of air ambulances. Only the Federal Government is authorized to make changes.
It is a short question that demands an elaborate answer. As the rural hospitals close at a rapid rate, air ambulances are playing a vital role in bringing patients quick access to emergency rooms. It is believed that, currently, a quarter of the population in the United States of America do not have access to medical care within an hour. It is air ambulances that fill this gap. A report reveals that 80 rural hospitals have closed in the past decade and over 700 rural hospitals, it is believed, will be closed in the next 10 years. Air ambulances are turning out to be critical services.
Time is a Factor that Air Ambulances Manage Well
A Federal rule says that air ambulances can traverse between state borders without having to worry about state regulations. This allows for seamless travel across borders without any regulatory hassles. If the states are allowed to regulate the air ambulance industry, it might so happen that traversing these now-free state borders could become lengthy or challenging to say the least.
A statistic says that over 30% of air ambulances cross borders annually. The state laws, if different from each other, might make flying the skies tricky, prompting the air ambulances to fly to another state because the regulations are less tedious. A report by American Stroke Association says that brain juries not getting treatment in time can result in fatality or poor recovery. That alone should be an argument enough in favor of Federal regulation.
It’s All About Reimbursements
The reimbursements rates by insurance companies have remained unchanged for over two decades. This puts a lot of financial stress on air ambulance service industry. Unable to get adequate cost coverage, organizations are compelled to go to the patients. Most disheartening is the fact that the patients who pay for this service are insurance holders but without adequate coverage.
Imagine heading a business where customers only pay you 30% of the time in full and the remaining 70% only pay you 50% of the cost. How would your business survive? This is precisely the situation of most air ambulance companies in the United States of America say industry experts. What adds insult to the injury is the fact that there is a outcry about the charges both in national media as well as people, not to mention the politicians who are trying to pin all the blame on air ambulance companies. Most players in the industry say that air ambulance business is getting harder by the day to run.
Air Ambulance Companies Asked to Do More
Rural hospitals in the US are closing down at a rapid rate. More and more rural patients are veering towards the services extended by air ambulance companies. However, the fact remains that air ambulance services are expensive and the costs are not being reimbursed by health insurance providers citing several reasons. While the most common is the ‘lack of medical necessity’ others simply have a small ceiling of reimbursements that have not been revised for a very long time.
Most of the Air Ambulance Costs are Fixed
Costs of running a medical base is, on an average, about USD 3 million a year. This amount accounts for about 85% of the costs and are fixed. These include maintenance of the aircraft, hangar, support staff, crew and the like. Then there are write-downs that are either forced upon the air ambulance companies or the ones that they undertake themselves on humanitarian grounds. All this adds up to a huge amount. Plus, there are always the running costs such as fuel which is also quite expensive. Industry experts feel that the demand for the services provided by air ambulance companies is going to increase considering that the population is aging, and that something needs to be done on a war footing to make the reimbursements commiserate with the services provided.
When faced with an emergency situation concerning the life of a loved one, cost is the last thing that you want to worry about. However, it is always wise to have an idea of the costs involved in emergency situations and medical flight services are one of those. With the cost having doubled over the past decade, you must know what to expect if you’re opting for a medical flight. While most of the costs will be covered by your health insurance, you would still want to keep the costs low as you might be forced to pay the unapproved balance amount as it so often is seen happening.
The Cost of Ground Transportation
One cannot completely discount the fact that a ground ambulance may be required to transport the patient. It becomes an absolute necessity when it’s a fixed-wing medical flight, which can only take off from an airport. Even choppers can, at times, not reach the patients owing to the terrain and ground ambulance services may be needed.
The Destination of the Medical Flight
This is an obvious factor. The longer the medical flight, greater the cost. The nearest appropriate treating facility might be quite far and sometimes across borders – all this ultimately translates into higher cost.
Medical Flight Landing Fees
The landing fees depend on the duration that a medical flight uses the landing facility. This becomes a part of the final bill.
Type of Medical Flight and Number of Medical Staff
Long flights typically demand fixed-wing air ambulances. These can be more expensive than choppers. They are generally better equipped and considered more comfortable. The number of medical staff is also a criterion. Certain medical conditions demand that professionals in more than one field of medicine be present in the air ambulance and this can push the costs up.
While there may be other cost factors too, the ones discussed above are the major ones.
Altitude decompression sickness is not unique to airambulance flights or to patients alone. It is a condition that is generally associated with high altitudes. It was only in the 1930s that this phenomenon was recognized by the medical community. The problem was observed in aircrafts as well as high-altitude hot-air balloons. Today, we have a better understanding of altitude decompression sickness, but still, we are not insulated from the dangers of this medical condition. It is a must that medical crews aboard airambulance flights are well aware of this. Here, we explain this condition in simpler terms.
This is What Airambulance Crew Members Need to be Aware of
The basis for understanding altitude decompression sickness is Henry’s Law, which says, “When the pressure of a gas over a liquid is decreased, the amount of gas dissolved in that liquid will also decrease.”
The concept is best explained with the example of soda. What do you observe when the bottle is opened? The formerly ‘calm’ liquid suddenly sees a flurry of activities. The air bubbles that previously were nonexistent suddenly show an insane urgency to escape the bottle, pushing their way through the liquid. Why does this happen? The answer is Henry’s Law.
When the bottle is sealed, the pressure inside is at a constant high, but when it is opened, the liquid is exposed to pressure in the atmosphere outside the bottle, which is comparatively much lower, so much of the gas escapes the liquid.
How Does Henry’s Law Relate to Human Body?
Human beings have high amounts of nitrogen gas throughout the body. When the airambulance is flying at high altitudes, if the cabin is not pressurized, the possibility is that nitrogen will escape the body, owing to the decreased atmospheric pressure that prevails at high altitudes. Of course, modern airambulance vehicles are well insulated from such dangers and can safely travel at high altitudes.
When time is of essence, no other transport is as effective as a medical flight. That said, there are limitations to this mode of medical transport too. A lot of issues also stem up owing to the fact that medical flight services are a recent addition all over the world. While they have been prevalent since decades, the extent of prevalence has shot up drastically in recent times. Here, we list a few limitations that one must be aware of.
Medical Flight Services have Limited Hours of Operation
According to law, no pilot can work more than a 12-hour shift in a day, regardless of whether he or she flies or not. Of course, some of the pilot’s time goes into the routine upkeep of flight logs, etc. but this does not necessarily mean the professional is paid less, and having several pilots is not a feasible option for most medical flight operators.
Extreme Weather Conditions can be a Problem
Think of land ambulances, their operation remains almost unaffected in any weather condition, but medical flight services are no insulated from this. Even the slightest hint sometimes can prevent their take off. It’s important to note there that haste to save a patient’s life can endanger the lives of the crew members.
Medical Flight Landing and Take Off
It is stating the obvious but airplanes naturally need proper landing facilities. Helicopters, on the other hand, can do with less space but it becomes a problem when receiving hospitals do not have a helipad, especially in urban areas, where space is always an issue.
Highly Trained Professionals are a Must
There could be two problems here. The first is finding highly experienced professionals to become crew members; this can prove tedious. Second, experience comes at a price and can, in turn, shoot up the costs.