Over the past few years, the medical flight services have steadily risen in cost, so much so that the cost has gone up at a whopping 5% per annum since almost the past 7 years. There have been concerted efforts on the part of state governments and the federal government to bring the cost of medical flight services down, at least to a ‘reasonable’ level. However, the definition of what is reasonable has been rather loose. In the midst of all this, it is natural that people in general are concerned about workers’ compensation and how it deals with medical flight services.
Handling of Medical Flight Services by Workers’ Comp
The big concern of most people is naturally whether they have to pay out of pocket in the eventuality that medical flight services are utilized for a work-related injury. Many would simply ask whether there is a possibility of a balance payment being demanded.
Such worries, however, have no basis to them. The amount would be settled by the insurance carrier and if the amount being approved by the carrier is less than what the air ambulance company is claiming, the victim of the accident need not be concerned. It is up to the medical flight services company and the carrier to come to a settlement. In most cases, the air ambulance company gives the insurance carrier a discount.
The Clash of Two Laws and the Way Out
Most states have fee schedules that define the extent of medical flight services cost coverage. However, ADA or Airlines Deregulation Act of 1978 allows air ambulance service providers to charge what they feel is reasonable without any questions being raised. The two laws can be, sometimes, contradictory to each other. However, in spite of all this, it still boils down to the air ambulance company and the insurance provider coming to a common monitory agreement, in case there is a dispute.
More often than not, we hear about skyrocketing medical flight bills that families are forced to pay. While it is natural for such families to feel victimized, having some prior knowledge about insurance coverage can prove helpful. If you are among those people who feel all they need to do is pay health insurance premiums, sit back and relax, here’s some news: your most basic health needs might not be covered. This mostly happens when the medical service provider is out of network.
Out of Network Medical Flights can Be Expensive
Take the case of 8-year-old Ben Millheim who met with an unfortunate accident fracturing his skull. The injury necessitated using a medical flight service to a hospital about 100 miles from the site of injury. While the boy survived and recovered well, his parents are still reeling under the $32,000 medical flight bill. Unfortunately for them, the medical flight service that they had used was out of their insurance network. As a result they are now liable to pay the service provider the ‘balance bill.’ In other words, they have to now shell out of their pockets the amount that their insurance provider has refused to pay the medical flight company for the reason that it does not come in their network.
It’s Almost Always a No-win Situation for Patients
Life-threatening injuries leave little room for checking whether a particular medical flight service provider is covered by the health insurance. While insurance companies flatly refuse to bear such expenses, it has been seen that air ambulance companies usually offer a discount to such patients. Plus, several states in the United States have passed legislation to limit balance billing; however, some states like Missouri have not. It must also be noted that there is no federal regulation that governs balance billing, leaving people vulnerable.
If you have Medicare coverage, you can get coverage for ambulance transportation to or from the hospital. The coverage also includes skilled nursing facility (SNF) or critical access hospital (CAH). It’s important to remember that Medicare will help you pay for ambulance services but only if other modes of transportation could be harmful for your health. This doesn’t necessarily mean you automatically quality for air ambulance transport either. First, let’s take a look at the medical necessity of availing ambulance transport.
Medical Requirement for Availing Ambulance Transport Under Medicare
Medicare will pay for the cost of emergency ambulance transportation in case of sudden medical emergencies with your health being in serious danger, provided that other modes of transportation like cars and taxi could endanger your health. You can get coverage for ambulance transportation if:
- You’re unconscious
- You’re bleeding heavily
- You’re in shock
- You require skilled medical treatment throughout the transportation
Requirements to Qualify for Air Ambulance Transport Under Medicare
The above-mentioned examples don’t necessarily qualify you fir air ambulance transport that is covered by Medicare. To be eligible for medical transport by air, your condition must require immediate and fast transportation that cannot be done through ground transportation. Medicare will cover for your expenses only if your condition fulfills the following requirements:
- Ground transportation can’t easily reach your location
- Obstacles like heavy traffic, long distances, etc. could prevent you from getting the immediate care that you require if you’re traveling by ground ambulance
There may even be a few but special instances wherein Medicare will cover for the cost of ambulance transport even in non-emergency cases. This is provided in case you have a doctor’s letter stating that your medical condition requires transportation with an ambulance.
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.
If you’re guessing that we are discussing more about health insurance, you must know that we aren’t. What we discuss here is the malpractice insurance and liability insurance coverage that an air ambulance service is mandated to provide. Let’s discuss each of the insurance individually and see what they mean for you.
Air Ambulance Service and Liability Insurance
What do you think of a car driver who does not have adequate liability insurance? The answer in one world would be “irresponsible.” The same holds good for an air ambulance service. You do not want to associate with an air ambulance service provider that doesn’t care for such responsibilities. In fact, all air ambulance companies in the United States must have a liability insurance cover of $20 million.
What if the air ambulance service you travel does not have liability cover? You don’t have to worry about that in terms of legality, it is entirely the responsibility of the service provider. However, such coverage is an indication of the air ambulance service provider’s reputation.
Air Ambulance Service and Malpractice Insurance
Of course, the last thing you want is a malpractice situation. There’s no doubt about that but medical malpractice does exist and you need coverage against it. Wouldn’t you want your physician or ground medical transportation to have malpractice insurance to feel secure? This should be no different for an air ambulance service. The law mandates that every air ambulance service in the United States has a policy that covers $1 million for medical malpractice.
Ask the Air Ambulance Service about Insurance Covers
The air ambulance service providers are under no obligation to make their insurance covers public. However, most reliable air ambulance service providers come forth with complete information regarding both liability and medical malpractice coverage. This shows that such providers are patient-oriented. If an air ambulance company is unwilling to discuss these details with you, perhaps you should look elsewhere for this life-saving medical service.
Alaska, the biggest state in the US is also one of the most thinly populated areas, apart from its rough terrains. Airambulance is often the only reasonable means of transport during emergencies. Most citizens of Alaska always opt for adequate cover through private insurance providers to cover any eventualities that may demand airambulance services. Airlift Northwest’s AirCare insurance program is one of them.
The Airambulance Insurance was Deemed Illegal Earlier
Late last year, AirCare was deemed illegal by the state due to a technicality. The problem arose when there was a change in the insurance company’s ownership. Thanks to Gov. Sean Parnell, the changes have now been made, so that the residents of Alaska can continue to enjoy the security of having airambulance coverage. The Governor had passed the bill specifically to accommodate insurance programs that reduce the “out of pocket” payment burden that people have to face. It was a part of the Affordable Care Act.
What does Airambulance Insurance mean for Alaskans?
Take the example of Lubins family. Their daughter, Ella, 13, had fallen off a horse and suffered life-threatening injuries including a skull fracture. She was immediately taken to Harborview Medical Center in Seattle via airambulance, as the local hospital was not equipped to handle the extent of her injuries. Ella was fortunate to get treatment on time and is now recovering. However, the cost had come up to $82,000. Thanks to the family’s insurance, they only had to pay about $9000.
In essence, airambulance insurance means the difference between bankruptcy and a normal life. The family only pays about $99 for this coverage. More than 3000 people in Alaska have so far opted for AirCare insurance coverage.
Airambulance insurance providers in Alaska also offer coverage to visitors. The coverage costs as little as $80 and runs for about 3 consecutive months.
We have seen far too many medical air services bills going unapproved by insurance carriers. It is sometimes hard to point a finger whether the insurance companies should be held responsible for payment or the medical air services. The state of North Dakota, however, has been trying hard to pass a legislation that ensures the burden is off the shoulders of the patients. However, medical air services seem to be up in arms against this legislation, and they seem to be making a valid point. Here, we look into this law and also the factors that are preventing its implementation.
Medical Air Services and Insurance
People who are not a part of Blue Cross Blue Shield are often left to fend for themselves when a huge medical air services bill comes knocking on their door. The reason is simple: most private insurance carriers do not cover the full air ambulance bills and only pay a part. Also if an air ambulance company is not a participating provider of your particular insurance provider, you might have to bear most of the costs yourself. But choosing the participating medical air services is not always possible when life is at stake.
The Government of North Dakota has realized this and is trying to force medical air services to become participating providers with all major insurance companies. The legislation also is trying to set cost limits, where the air ambulance companies cannot charge more than the upper limit set with the insurance providers.
Medical Air Services are Against the Legislation
Federal laws state that states cannot regulate medical air services. Certain air ambulance companies are vehemently opposing this legislation stating that the law would amount to interference that is beyond the purview of the state governments. In fact Valley Air Med has openly challenged this legislation in US District Court in Bismarck. The US Department of Transportation too seems to be siding Valley Air Med’s argument as it feels medical air services should only be guided by federal laws.
As things stand currently, Valley Med Flight has become a participating provider but has voiced its dissatisfaction with Blue Cross Blue Shield payments.
There are certain non-emergency situations which can warrant air ambulance transport as apposed to other means of medical transportation. This could even be for diagnostic purpose. If the insurance is to cover this amount, the statement delineating the necessity for air ambulance transport must come from the treating physician. The amount would then be covered by the insurance provider of the patient.
What if you don’t have insurance? This is when you really need to start thinking about the cost. Typically air ambulance transport utilizing a twin-engine airplane would cost about $2500 for a 55-mile flight. The amount can go up to $50,000 for longer distances within the country and international flights can cost above $200,000. The cost is most of the times unavoidable.
Having Air Ambulance Transport Membership Can Help
Air ambulance memberships come in various forms. Some memberships are specifically designed for international travel. They give you the security of travelling abroad without worrying about air ambulance transport costs to your home country in case of emergencies. There is usually a nominal annual fee involved.
Certain other type of memberships give you the liberty of paying only such amount that is not covered by the insurance company. For instance, if the cost of air ambulance transport was $100,000 and the insurance pays only $80,000, you would have to pay out of pocket in case you don’t have a membership. Having a membership rids you of this worry.
Things to Keep in Mind to Ensure Adequate Air Ambulance Transport Coverage
Most of the memberships are provided by individual air ambulance service providers. One needs to check out whether the provider you choose has a good network in your region. Checking whether your insurance provider has a tie up with any air ambulance transport company is also vital. If you are travelling abroad, check your travel insurance, and if need be, buy separate coverage, especially if you are going for a high-risk adventure-filled vacation.
Shauna Laswell recently suffered chest pains and was taken to a local hospital; however, she was diagnosed as having a heart attack. She had to be emergently flown via air ambulance to a Las Vegas hospital. Shauna did get great care and survived the medical emergency. When she received the bill, she was just short of having another heart attack – it was a whopping $38,800! Thanks to her insurance provider who did not cover the air ambulance cost, she got a reimbursement of only $6,200.
Why Was Shauna’s Air Ambulance Bill Not Covered?
Anyone would wonder why air ambulance bill was not covered, as heart attack is a life-threatening situation and definitely warrants an air ambulance flight. For one, the nearest medical facility was not the one she was taken to. Insurances only cover the distance to the appropriate nearest medical facilities. So, the vital question is, “What can I do to avoid a situation like this?”
Few Tips to Ensure Adequate Air Ambulance Insurance Coverage
Remember that only travel to the nearest medical facility is covered by insurance. Also, you are better off hiring the services of the air ambulance attached to the hospital, rather than hiring an independent medical flight service. The ones attached to the hospital are usually cheaper.
Look at the kind of coverage that your insurance provider provides. If there are clauses that keep you from getting full air ambulance cost coverage, steer away from such providers. Most air ambulance services have membership programs. Being a member of such a program gives you immunity against the amount not covered by insurance company. The air ambulance company itself would cover such amount.
Be prepared for eventualities. Air ambulances are being increasingly used these days. So, request for the air ambulance provider that you prefer. Know the air ambulance services that are affiliated with your insurance provider.
Most of the time, insurance companies do not cover 100% of the charges for air ambulance services. The Utah State Insurance Department has even issued a warning to the public in this regard.