Tag Archives: Balance Billing

Air Ambulance Transport Industry – Is ADA of 1978 Serving Its Purpose?

The Airline Deregulation Act of 1978 has found mention far too many times recently. Every attempt by insurance commissioners and insurance industry has been successfully countered by the air ambulance transport industry, thanks to this act. At the outset, the act itself seems arbitrary considering it takes away the power to control prices by the democratically elected state governments. Then why was this bill introduced in the first place? This is the question that comes to mind often. It was originally passed so that competition can be encouraged. However, it is questionable whether this intent is still being served in the current industry context as prices are simply shooting up. In an ideal competitive world, the prices must be well controlled.

FAA Reauthorization Act of 2018

It must be noted that only the Federal Government can make changes to the existing ADA of 1978. Considering the growing voices against the act, the government enacted FAA Reauthorization 2018. While some were hopeful that it will make drastic changes to the exiting act, it was not to be. The new act limited itself to making provisions to appoint an advisory committee to take a closer look at the air ambulance transport industry and the financial burden on the patients. It has no powers to implement any changes and is limited to offering advice only.

Balance Billing and Air Ambulance Transport Industry

Balance billing continues to be a problem. The healthcare insurance industry, it looks like, refuses to change its reimbursement model for the air ambulance transport industry. It has remained unchanged for over two decades now. On the other hand, medical flight companies are refusing to conform to the prevailing reimbursement rates and adamant against going under insurance networks. The result: balance bills that are not covered by insurance are being thrust upon the patients and they are being compelled to foot bills that amount to thousands of dollars. A solution does not seem at sight, at least at this juncture.

Are Some Medical Flight Companies Acting Unfairly? How do You Find Out?

Let’s understand the scenario with a hypothetical situation – a patient has suffered a serious injury and is in Carthage, Missouri. It is felt that the most appropriate facility to treat the patient is in Joplin, which is just about 12 miles from where he is. A medical flight is summoned, in spite of the ground ambulance being ready to take the patient. The medical flight takes about an hour to reach the patient and another 15 minutes to reach the treating facility. A week elapses, just when the patient is thanking his stars that he was lucky to receive the treatment on time, he is slapped with a balance bill of $25,000. The insurance company has covered $20,000 of the total $45,000 bill. The once happy patient is now contemplating mortgaging his house to pay off the balance bill.

The Argument Against Medical Flight Company

The insurance company argues that the ground ambulance was readily available and the destination was just 12 miles away, which would have taken the ground ambulance about half an hour to reach. Yet, a medical flight was called in, even though it took an hour for it to simply reach the patient. The insurance company feels there was no need for the medical flight service in the first place and refuses to cover the bill in full. In the outset, the argument seems right but only until what the medical flight company has to say.

Looking at the Situation from the Medical Flight Company’s Angle

Medical flight companies do not and cannot choose to take a call whether they want to fly a patient. They are summoned by the hospital and the medical necessity is decided by the treating physician. Come to think of it, the treating physicians usually have a sound logic behind suggesting an air ambulance service. The ground ambulance might not be best suited, owing to the patient’s condition.

What needs to be done in contradictions like these is following a middle ground and for this, there needs to be a mechanism in place where things are sorted out between medical flight and air ambulance companies. Until that happens, the patient will continue to suffer.

A Quick Guide to Know US Air Ambulance Industry Better – Frequently Used Terms

There’s a lot happening in the US air ambulance industry at the current time with people opposing high bills, law makers coming up with newer regulations, and medical flight companies demanding more accountability from the health insurance industry. These happenings will, ultimately, affect the common US citizens. Here’s a glossary of sorts that allows you to understand certain points pertaining to the US air ambulance industry.

ADA of 1978 – the act that governs US Air Ambulance Industry

ADA stands for Airlines Deregulation Act. It was enacted in the year 1978 and has since governed the aviation industry in general. This is a federal act and prevents the states from interfering in the affairs of US air ambulance service providers when it comes to price, route and service.

FAA Reauthorisation Act

The abbreviation FAA stands for Federal Aviation Administration – the body that regulates aviation services in the US. The Reauthorisation Act is currently under consideration. If passed, it will give the states the ability to interfere in the matters pertaining to price, route and service, but only when it comes to the US air ambulance industry. The Act is a response to people’s demand to the government to look into the skyrocketing medical flight bills.

In-Network Air Ambulance Service Providers

Most US air ambulance companies have an understanding with insurance providers to cover their services, at least in a given location. These medical flight companies are considered “in-network” by the insurance providers, and mostly, full coverage is given if their subscribers opt for these medical flight companies.

Balance Billing

In most instances insurance companies only cover a part of the air ambulance bills. The medical flight companies are forced to cover the remaining money from the patients directly. In other words the balance amount is billed to the consumers.

ADA Pre-emption

The ADA of 1978 is clear that states cannot interfere in the affairs of US air ambulance companies when it comes to price, route and service as mentioned above. If an air ambulance company is sued with regards to any of these, it enjoys pre-emption from such lawsuits.

US Air Ambulance Memberships

Most US air ambulance companies offer annual memberships at a nominal fee. These members enjoy complete insulation from balance billing. The membership is an additional layer of protection over and above the health insurance.

Taking a Medical Flight? Know what ‘Balance Bill’ is

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.