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.
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.
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 adoption of private equity is not just a predicament for the air ambulance industry but the entire healthcare system in the United States. Several financial institutions in the country have shown a keen interest in healthcare in recent times. There is no doubt that it makes the whole sector highly competitive with ready access to funds. However, what bothers most people is the profit motive of private equities. The healthcare and air ambulance industries being more human-centric, it does not seem right to most people that they are viewed as a source of profit. They opine that healthcare must be a pure welfare activity.
What’s the Air Ambulance Industry Got to Lose?
Many people believe that the high prices charged by air ambulance companies are directly a result of heavy private equity investment in them. Investors simply do not want to make any losses, even though the United States is flooded with several air medical transport companies, so much so that the consumer base is starting to look too small. This is causing more idle time for many companies. As a result, their costs are piling up and are being ultimately transferred to the customer.
Will the COVID-19 Pandemic Transform the Industry?
The COVID-19 pandemic has drastically cut down the demand for air ambulance services. The reason behind this is simple. The industry relies heavily on helicopters, which are not built to handle highly infectious diseases like COVID-19. The pandemic has given no adaption time to the air ambulance service providers. The lack of isolation between the crew and the infected patients, in addition to the sanitization needs, has made air medical transport not the best option, at least locally. However, they are still being utilized for international evacuations, although not large in numbers.
Experts opine that, if the prevailing low-demand situation persists, there are going to be several service providers who will be forced to shut down, creating a balance between the number of players in the market and the size of the market.
We have been quite vocal about the fact that air ambulance services will have a crucial role to play in the fight against COVID-19 as the battle hardens. It seems that the industry is now an integral part of the fight. Amid challenges that are being faced by medical flight crews and companies, they have displayed exemplary grit to keep the services afloat.
Air Ambulance Services are Brining Back Americans
Most internal national borders today stand sealed down. Only those flights that have special permission are allowed to fly between countries. Commercial flights are increasingly being used to fly patients who are not infected. However, there are a lot of Americans out there who are battling COVID-19 infections in foreign lands. Air ambulance companies are now helping evacuate them. The effort is ongoing at a war footing in the Caribbean and Latin American regions. A Florida-based air ambulance company is leading it currently. The medical flight crew consists of two medical professionals and two pilots enveloped in biohazard suits.
Phoenix Air is Leading the Fight in the Air
Phoenix Air, at the current time, is the only air ambulance company that is equipped to tackle highly contagious diseases. It has two Gulfstream G-III aircraft that feature Aeromedical Biological Containment Systems or ABCS. They are capable of carrying 4 infected patients each. The system was put in place during the Ebola crisis and had proved highly successful. The model is now being used to fight the COVID-19 crisis. The medical flight company plans to add two more specialized aircraft to its fleet.
Support for Air Ambulance Operations in the UK
The UK is again leading the way when it comes to offering support for the medical flight industry. It is believed that the Great North Air Ambulance service will now be offered free fuel during the crisis. Fund-raising is a big concern for the industry in the country due to the current COVID-19 situation.
Keeping medical flights afloat during the ongoing COVID-19 spread is turning out to be an uphill task for most air ambulance companies. Several issues that were never thought of before are surfacing now. Shortage is a word that is widespread in the industry today. We take a look at some of the issues that are hindering the functioning of the industry.
Professionals Being Moved Away from Medical Flights
The shortage of frontline, qualified medical staff is a well-known problem in the current scenario. No amount of frontline medical workers is proving enough to tackle the growing COVID-19 pandemic. Obviously, staff serving medical flights is being called to fill this deficit. The development is quite understandable, but it is certainly hindering the air ambulance services.
Lack of Adequate Medical Flights
COVID-19 has given too little time for medical flights to adapt. Isolation facilities are not good enough to carry infected patients in most medical flights. Employing these can, no doubt, put the frontline workers at risk of contracting the highly contagious infection.
Lack of Personal Protective Equipment
Personal protective equipment is essential if emergency workers are to function seamlessly. However, every country around the world is currently facing a shortage of these. This is a huge roadblock.
Fall in Emergency Cases
The lockdown that is being followed in almost all countries around the world has translated into less road traffic, and as a consequence, MVAs have gone down. Also, it is not easy for people to procure illicit substances, so related cases have also gone down. There is, therefore, a slight slump in demand, which is quite welcome.
Once the world goes back to normal, it is expected that the medical flights too will be able to function normally. Until then, the industry will function as efficiently as possible given the constraints.
The job of the air ambulance professionals is tough no doubt but it has gotten tougher owing to the ongoing COVID-19 pandemic. Today, the healthcare workers are exposed to the risk of contracting the Coronavirus infection which has enveloped the world in a dreadful storm. While the usual precautions that are taken by the general public apply to the air ambulance professionals too, there are additional precautions that are expected to be taken by these frontline workers. Washing hands, keeping alcohol-based sanitizers, and face masks apart from protective bodysuits are just a few of the obvious ones. We take a look at other precautions that must be taken by the medical flight workers.
CPR is a Risk for Air Ambulance Professionals
A lot of the emergency calls that air ambulance professionals receive are related to drug overdoses and cardiovascular problems. Both of these conditions can necessitate cardiopulmonary resuscitation or CPR. However, in the face of the Coronavirus infection, this can pose a real, life-threatening problem to the healthcare workers. The constant compression of the chest can release salivary particles that can enter the system of a healthy individual through the air or simply settle down on the clothing. If the CPR is being conducted in a closed environment, the risk can compound itself greatly.
Only the Very Serious Emergencies Must be Attended
Even hospitals today are considering only tending to the very serious cases that need hospital attention. The emergency department professionals are donning full protective gear when taking a look at emergency cases. The reason for this is obvious: they have no idea whether the symptoms are because of COVID-19.
Hospital emergency departments are asking the frontline on-the-field healthcare workers to wait for a while and try to revive them before even considering bringing them to the hospital for further care.
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.
Imagine an emergency situation where a cruise ship is stranded in the middle of the ocean with hundreds of people on it. The only way out is an air ambulance service, due to time constraints and the less-than-ideal condition of the ship. However, there is one big challenge. Helicopters can only function one at a time due to turbulence. While multiple choppers can be put into play, only one can hoist people at any given time. That is not the end of it. The hoists that are commonly used are only capable of carrying one person at a time, and it roughly takes about three minutes at a minimum to onboard one person.
How can an Air Ambulance Enhance Hoisting Capacity?
Traditionally, air ambulance helicopters have gone with hoists that are capable of carrying about 500 to 600 pounds of weight at the max. This translates not to more than two people. Also, often, rescuers have to be on the hoist to assist in the evacuation. This makes the whole process inefficient and time-consuming. However, today, thanks to advances in technology, hoist baskets are being produced. The design and metallurgical expertise make them light and sturdy. These are capable of carrying up to 4,400 pounds and can accommodate up to 15 people at a time.
The Capacity of the Helicopter also Matters
Baskets are available in various capacities. Depending on how powerful the chopper is, an appropriate basket can be chosen. The baskets are approved by the regulatory authorities too. They are considered not only safe but also very comfortable. These baskets are brand named Heli-Baskets and currently are in production. If adopted by the air ambulance industry with open arms, these rescue equipment can change the way hoisting is conducted during rescue missions. They can make the whole exercise cheaper, quick, comfortable, and efficient.
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.