It is believed that the medical flights will be in great demand for most part of the next two decades and will grow at a rate of 9.3%. In the past year, the industry grew to US$ 4,524.7 million. Those are some robust numbers and not the kind we commonly see in the prevailing economy. What are the driving factors behind these trends? It is certainly not the affordability of the people as evident by the growing concerns surrounding the balance bills that never fail to make the headlines. It is the medical need that is driving the air ambulance industry. Here are some sharp insights.
Medical Flights and Diabetes
Perhaps the most common lifestyle disease that prevails today is diabetes. While there is nothing that cries emergency about diabetes, it is a cause for more serious ailments. People with diabetes are known to eventually develop serious heart and kidney conditions, which give rise to life-threatening emergencies. This is where medical flights come into picture. With the US fighting obesity and diabetes (as a consequence), the market is set on an upswing. In fact, currently, there are about 463 million diabetics in the country, and it is projected to reach 700 million in the next 25 years.
Medical Flights and Drug-Related Emergencies
The illicit drug menace has bothered the country for long. Today, it is believed drugs are among the biggest killers when it comes to people under the age of 50. A lot of times, these give rise to serious and unexpected medical emergencies ranging from overdose to motor vehicle accidents. Medical flights are the only recourse in most cases.
Medical Flights and Rural Hospitals
It is a known fact that rural hospitals have been closing down at a rapid rate in the country, and the trend has been up since a decade now. Medical flights are the only way out for the residents of such areas.
In a way, the market for medical flights is a reflection of how healthy the society is.
The air ambulance industry has been in the headlines for quite some time now. Most recently, however, it was because the state of Wyoming was attempting to regulate it. The hurdle was (and is) a federal regulation that prohibits state governments from interfering in the affairs of air ambulance industry. However, the attempts were rejected by CMS. Wyoming had proposed that the states must be allowed a say in the matters of air ambulance industry. It had done so to keep the cost of medical flight services at bay as they have been getting steeply expensive recently.
Does this Mean the Air Ambulance Industry has Won?
The answer is “yes.” At least for now, the air ambulance industry seems to have won. The CMS verdict favors the medical flight service providers. They will not be subjected to any state control and will be free to fly across state borders and also charge the consumers what they feel is the right amount.
The industry had feared that if they are forced to come under insurance networks, they will then have to conform to the reimbursement rates that are set by the insurance organizations. This was especially worrying since the rates have not been revised in over a decade. Moreover, since bidding system to offer services for a particular state would have come into picture, there were high chances that some insurance companies would have gone out of business.
What does it Mean for Consumers?
Consumers will now have access to a wide range of air ambulance companies. This means they will be able to avail specialized medical flights during emergencies. Since the profitability will remain unchanged, the air ambulance industry would find it financially encouraging extending their reach to remotest parts of the country. There, however, is one drawback. Since insurance companies have not still revised their reimbursement rates, the consumers are at risk of high out-of-pocket expenses.
A recent survey has shown that medical flight services are now more open to insurance network participation. In fact, the numbers have gone up by a healthy 20%. It has also been seen that the medical flight services and insurance companies are holding intense discussions and negotiations surrounding in-network arrangements.
The reason behind this change has been the huge increase in consumer demand and also to steer clear of the negative publicity that both the industries have been subject to in recent times. The efforts by the state governments to regulate air ambulance pricing and also getting insurance companies onboard with their cost-controlling measures have seen a lot of backlash recently.
The Medical Flight Services and their Cost Compulsions
The refusal of the insurance companies to take cognizance of the fact that maintaining medical flight services is an expensive affair – some say – was the cause of all the misunderstanding. Air ambulance companies usually spend a fortune to remain on standby for emergencies. The cost, of course, is then transferred to their services. When insurance companies refuse to foot these costs, the burden unfortunately is transferred to the patients who avail the service. This is a practice that is popular as ‘balance billing’.
How In-Network Coverage Helps
Customers are able to enjoy discounted and ‘fair’ out-of-pocket expenses to cover medical flight services when in-network coverage becomes a reality. In an ideal world, all air ambulance services providers must be in-network. However, the onus of it does not lie only on these emergency service providers. The insurance organizations too must be willing to reimburse a fair amount. Otherwise, it simply does not make business sense for medical flight services to join any network.
The good news, however, seems to be that both these industries are coming around and finding common grounds to work together.
When it comes to communities funding air ambulance services, United Kingdom leads the way, and there is no doubt about it. It is the involvement of the locals that makes it happen. People are known to undertake several community efforts, no matter how small, to keep the medical flights funded. From marathons to selling cookies, people contribute in their own way through innovative fund-raising efforts. The question that such undertakings raise is this: does this method work across the board? The answer to this simple question, however, is quite complex and the success is dependent on several factors. Let’s take a look at some of them.
The Absence of Significant Private Air Ambulance Companies
In a country like the United States, there are several private players who do an exemplary job to provide air ambulance coverage. They span a wide network of rural areas with zero compromise on quality of transport. The problem, however, is the price that they charge. In the absence of adequate insurance coverage, they can turn out to be a huge challenge to pay off. Of course, there is the issue of network coverage and surprise billing that has got the country concerned lately. This is the prime factor that is pushing people to look at alternate means of funding air ambulance services.
Community Funding is Not Always Successful
The estimated cost of keeping air ambulance services floating runs over a million dollars. Even the most successful charitable medical flight services do not rely solely on community funding to satisfy this need. Governments and corporate organizations play an active role in their funding. Moreover, prominent personalities are known to raise awareness and extend support to raise awareness about the services. In the United States, however, such an ecosystem is completely missing. Unless there is a concerted effort to get it in, such efforts are bound to fail.
There has been much anticipation surrounding the new air ambulance bill that aims at curtailing surprise billing practices. However, experts opine that the draft leaves much to be desired for both parties – the payers and the air ambulance service providers. The feeling is that the lawmakers have tried to take a middle ground so as to not displease the air ambulance industry or the medical insurance industry.
From the insurance industry point of view, the fact that it suggests an in-network rate even for those medical flight service providers that are out of network seems like a big win. The provision is something that payers have wanted all along.
From the air ambulance industry point of view, the draft allows for arbitration if there is a dispute with regards to the billing. However, since this comes in the backdrop of a set rate, the industry is not too happy about it.
How is the Air Ambulance and the Wider Healthcare Industry taking it?
The American Hospitals Association has strongly opposed the draft. Their reasoning is that it harms the rural hospitals by limiting the access that patients currently have. The association went as far as saying it is a ‘windfall’ for the insurers ‘at the expense of’ community hospitals. American Association of Medical Colleges too has opposed the draft.
America’s Health Insurance Plans has displayed its dissatisfaction surrounding the provision for arbitration.
More about Arbitration
When it comes to air ambulance companies, arbitration will only be possible for amounts over $25,000. The industry is also expected to provide two years’ worth of data pertaining to costs. This data would be provided to US Transportation Secretary as well as HHS.
The air ambulance industry has been vocal in raising the concerns surrounding patient safety as well as closure of medical bases. They also pointed out that the current insurance payouts by Medicare and Medicaid do not cover even 40% of the costs.
The United States of America spends the highest amount of money on healthcare in the world. It was already at $2.9 trillion in 2013, which has only increased since. This is not necessarily a bad thing as patients invariably get excellent medical care throughout the country.
The insurance too, for the most part, covers the expenses well, although it’s a bit long-drawn sometimes. However, air ambulance service coverage has been a bone of contention for sometime with most of the blame going to the air ambulance service provider rather than the insurance companies. Take the instance of air ambulance services in Montana.
Air Ambulance Service in Montana
Montana is mostly comprised of rural areas, so speciality healthcare is not always available close by, necessitating use of air ambulance service for adequate treatment. The air ambulance services are not always covered by insurance companies in full and the reason given is that the service is not “in-network” and only the companies that are in the insurance network are covered.
Bargaining Power of Air Ambulance Service Providers Matters
To get to the core of the problem, one needs to understand the negotiations held between air ambulance service providers and insurance providers. In a place like Montana, there are a few insurance providers; in fact, there are just three. This gives the insurance companies huge bargaining power when fixing an amount that would be given to the air ambulance service provider. Most air ambulance companies are wary of settling for a low price as it doesn’t adequately cover the cost. As a result, they choose to stay out of the network. Insurance companies only cover air ambulance services in full if they are offered by companies “in network.”
Moreover, the patient rarely gets to choose an air ambulance service provider. Last year alone, Montana saw over 3,000 medical flights. There needs to be some consensus between all the insurance providers and air ambulance service providers if the patients are to benefit in the true sense.
You are just recovering from a serious health issue that demanded immediate attention. The matter was so urgent that it warranted an air ambulance transport. Just when you think that the worst is over, you are hit with a huge air ambulance transport bill. You breathe a sigh of relief knowing that you are covered by your insurance. Then, another shocker: the insurance company refuses to foot the entire cost. You suddenly find yourself spending sleepless nights not knowing how to foot such a huge air ambulance transport bill. Don’t worry, there’s still hope for you.
The Air Ambulance Transport Bill could be a “Sticker Shock”
It’s not unheard of in the healthcare industry where the listing prices are kept very high and air ambulance transport industry is no different. The prices are significantly lowered later, depending on the negotiating capacity of the patient. It is not unusual for air ambulance providers to come down to half the listed price. Some even offer flexible payment options.
Insurance companies that have huge number of subscribers are most likely to get huge discounts from air ambulance transport companies. Another factor is payment in cash. If you have the resources, the discount could be great. Also, you stand to gain if the air ambulance transport company is in the network of your insurance provider.
Community-Based Air Ambulance Transport Programs
Is the air ambulance transport company that you chose a part of community-based air ambulance transport program? If it is, then you’re lucky. The price is going to be low and is very likely to be covered by your insurance program. However, some air ambulance transport companies remain out of such community-based programs. These companies usually charge a huge amount which is not always covered by insurance companies. The amount not covered is usually recovered through the patient. If you have been served by one such air ambulance company, you might want to negotiate hard with the air ambulance transport company.
The different states of the United States are also in the process of designing a priority list which will mandate that health care providers give preference to community-based air ambulance transport companies before calling a provider who is out of such network.
Air ambulance services are the only option most of the time when a patient suffers a severe heart attack, stroke or any other medical eventuality. The sad part is that, during such times, most patients are neither in a position to deny air ambulance services nor choose one on their own. For this reason, the Nebraska Department of Insurance has come up with certain guidelines to keep the patients away from financial shocks.
How Much Does Air Ambulance Typically Cost?
The numbers can run anywhere from $12,000 to $25,000 per flight and these numbers only cover domestic flights. If the requirement of air ambulance is to fly overseas, the price can go well over $100,000. The Association of Air Medical Services says that over 550,000 patients make use of air medical evacuation each year. A sizeable part of this population later faces problem when it comes to payment of the bills as insurance companies refuse to cover the entire charge.
Understanding Air Ambulance Insurance
Insurance companies will only pay the bills when they deem the use of air ambulance absolutely necessary for the patient’s survival. There are times when insurance companies refuse to foot the bill or part of it.
When it comes to Medicare, it only pays if it determines that the necessity for air ambulance is immediate and that ground ambulance cannot do the job. Also, it only covers the cost to the nearest appropriate medical facility.
What is the Solution?
The first and foremost thing to do is read all the details of your insurance cover thoroughly. In case you need additional cover, purchase it beforehand. Know all the terms and conditions. Here are some of the questions that should bother you:
- Will the insurance cover equipments like oxygen and life support onboard the air ambulance?
- Will the cost of transportation to and from the air ambulance be covered?
- Will the cost of family member accompanying the patient be covered?
- Is there a limit to the distance covered?
- What types of emergencies are covered?
It is important to note here that the only way to keep yourself away from a financial doom is to think about air ambulance when you’re healthy.
So your credit card says that it will get you medical help during times of emergency. But does that mean you can rest assured that you will reach your home in the United States? What you need to do is read the fine print. If a part of the terms and condition reads that you will be transported to the nearest appropriate medical facility, you might be in trouble. Yes, you might get help, but you might end up getting that help quite far from you home and sometimes not even in your home country. Now, if you are travelling overseas, this can pose serious concerns for you, and you might still end up paying tens of thousands of dollars for evacuation via air ambulance transport.
Ensuring Adequate Air Ambulance Transport
If you are going to rely on your credit card to cover the risk of using air ambulance transport, ensure that you get answers for the following questions:
What is the financial limit of the air ambulance transport?
Some credit cards might set a limit beyond which you might have to pay out of pocket. Knowing the limit will help you prepare financially.
Are there any terms and conditions?
If the credit card does not cover air ambulance transport for pre-existing illnesses, you might be in trouble when your existing illness like a heart condition flares up unexpectedly. Moreover, it is important that you cover this risk as you are more likely to need air ambulance transport for a pre-existing condition.
Do I have the privilege of choosing the hospital?
You do not want to end up in a hospital that is too far away from your home. Also, you might not feel confident getting yourself treated in a hospital that you do not know of.
Can my family travel with me?
You might want your family to accompany you during your air ambulance transport, just so that you feel reassured and comfortable, so check whether your agreement with the credit card allows you this privilege.
At the end of it, there are credit cards that allow you good coverage for a reasonable price. On your part, be wise and proactively check what you are getting into so that you remain safe.
If your loved one is in need of air ambulance transport and if you have enough time in your hands to choose among the various service providers, would you still opt for a broker to choose one? If your answer is yes, think again. Here, we list a few reasons as to why you are better off scouting for an air ambulance transport yourself.
Cost of Air Ambulance Transport
An air ambulance transport broker usually pours in all efforts to give you the cheapest available option out there. Of course, this is good but one needs to keep in mind that the cheapest is not always the best. It is necessary to look into other aspects too. Moreover, the broker will invariably add his charges to the overall cost of air ambulance transport. If you look for an air ambulance yourself, you can save this money.
Ability to Answer Questions About Air Ambulance Transport Service
Keep in mind that the broker is not a representative of the air ambulance transport company. He would therefore have limited knowledge to allay all your fears and concerns. This can be a major disadvantage if you are anxious about the whole thing. When you choose to find an air ambulance transport company yourself, you would be dealing with the representative of the company who would be in a better position to clarify all your doubts.
Do the Legwork for Air Ambulance Transport Yourself
Spending a bit of time to find an air ambulance transport service yourself can free you of a lot of worries. Most of the time, all it takes is looking online for a few phone numbers of air ambulance companies and calling them up. The air ambulance transport coordinators would do the rest of the work. Spending a couple of hours to perform this task can save you money and worry.