An insurer has gone to the Kansas Supreme Court dragging a medical flight company. The contention has been that the company has been charging unreasonably high prices for its services. Terming the practice of billing ‘predatory’, the petitioner has asked the court to intervene, although the medical flight industry has been insulated by a federal law that bars states from interfering in the matters of billing. The court is yet to pass a ruling, and the service provider in question is EagleMed. The air ambulance industry argues that high charges towards privately insured people are a way to offset the losses resulting from uninsured people or those with Medicaid and Medicare.
The Tough Competition in the Medical Flight Industry
There are several players in the medical flight industry today. This means more service providers for a limited number of service seekers. This makes it incredibly hard for most companies to stay afloat because they fail to get enough customers to balance the costs. As a result, the cost of maintenance is distributed among those who avail of their services. The federal law acts as a shield allowing these companies to employ this practice.
The Federal Law is Aimed at Staying Competitive
The Airline Deregulation Act of 1978 is a federal law. It is aimed at airlines, and since the medical flight industry is considered a part of aviation and not the healthcare industry, the Act holds good for it too. However, the main purpose of this act is to encourage competition to lower prices. This is not the case with air ambulances. Since the patients have little say in the service providers that they choose during emergencies, the medical flight companies get a free hand to charge as they please. The insurance companies, on the other hand, have not changed their coverage for years together. This translates into lower coverage, and the ultimate burden of clearing the bills falls on the customers.
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.
Imagine this – you pay for a smartphone in full and then realize that you are only allowed to use certain features in it but not all. How would you feel about that? Would you have bought it had you know about this fact during the time of purchase? Now, take the case of air ambulance coverage provided by insurance companies. Don’t you deserve to know the kind of coverage that you get? Whether you would be monetarily covered in your neediest hour when your health demands urgent medical care? You need to be sure you will be taken to a well-equipped treating facility and that the expense of carrying you to that destination is covered by the insurance provider. Unfortunately, that is not the case today.
Not All Insurance Providers are the Same
There are several health insurance providers out there who cover the air ambulance charges at a fair rate but there are others who do not. On the other hand, it is not under the control of the air ambulance service providers to choose patients. They ask no questions; they simply respond to emergencies. When this act turns into a haggle for money, it becomes a problem. The result, often, is balance billing – the part of the bill that remains uncovered by the insurance provider. The balance bill, ultimately, becomes the responsibility of the patient to pay, despite having insurance coverage. The amount can be so huge sometimes that it can push a common man towards bankruptcy.
Patient Advocacy by Air Ambulance Service Providers
Most air ambulance service providers have a robust policy when it comes to patient advocacy. Such programs are mainly targeted towards helping patients course through the complexities of insurance. However, the question is, why should such programs be necessary. All that is needed is a fair rate at which insurance companies reimburse the air ambulance service providers. As the insurance companies and air ambulance companies sort this matter out, what ultimately comes out is something that we all need to keep an eye on.