One of the most basic criteria for insurances approving and covering costs of medical flights is establishing that there was actually a medical necessity for availing the service. However, understanding what constitutes a ‘medical necessity’ is important. Of course, we have discussed, in our earlier guides, that the decision to summon air ambulances can only be taken by the treating medical professionals in the hospital or at the site of accidents. Let’s dive into this topic a little deep here.
Medical Flights and their Advantage Over Ground Ambulances
It must be established or deemed important to leverage the advantage that medical flights have over ground ambulances. The instability that comes with transporting a patient via ground ambulance and the need for rapid medical transportation could be the two reasons to avail medical flight services. Further, the condition of the patient should be such that he or she could suffer serious medical consequences or even face death if an air ambulance is not used.
Accessibility of the Destination
An air ambulance can become a ‘medical necessity’ if the destination is located in a region that is remote or completely inaccessible to other forms of transportation. The ground approach to the destination could be such that it poses a serious threat to the patient owing to the terrain.
Time Taken to Reach the Nearest Treating Facility
There are times when a delay as small as 30 minutes to an hour can mean the difference between life and death. The ground ambulances may be available in such scenarios but the time that they take to reach the treating facility could be a deterrent and the advantage of quick transportation that comes with medical flights could be the advantage. Of course, the severity of the illness or the disease condition would be the primary factor behind this decision.
‘Stringent’ is the word that comes to mind when you think of medical flight insurance coverage norms. Cost reimbursements of medical flights can mean between a retaining your life savings and letting it go to cover the huge bills. It is important to know the basis on which insurance companies accept or deny the claims. Of course, the foremost thing is to own a health insurance policy that covers medical flight services or medical transportation of any form for that matter. If this condition is taken care of, following are the other conditions that you must be mindful of.
Insurance Coverage for Medical Flight Services
Medical flight services to and from hospitals are covered by Medicare Part B. It is worthy to note here that air medical transportation to skilled nursing facilities is also covered under Part B. However, it should be noted that medical flight coverage is provided when it is deemed that ground ambulances are not suitable for the medical condition or when it is determined that the patient is in dire need of care and timely care is possible when the patient is carried to the treating facility in the shortest possible time via an air ambulance.
Approval by the Treating Professional is Necessary
The ultimate decision of whether a medical flight service is necessary lies with the treating professional who could be a physician or a paramedic attending an emergency. This decision cannot be taken by the patient and in most cases cannot be overruled either.
If the medical flight company feels that the patient might not be able to pay for its services, it can ask the patient to sign Advance Beneficiary Notice that states that the patient would be responsible for the payment in case the insurance company refuses reimbursement. The patient can refuse to sign this notice; however, if the air ambulance company goes ahead and carries the patient, he or she might still be held responsible for the payment.
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.
Americans today seem to have a false sense of security thinking that everything related to their medical wellbeing is automatically covered by health insurance. The reality is far from this belief. The health insurance providers differentiate between hospital expenses and medical air transport. While a good insurance will cover almost the entire medical treatment bill, the same insurance would hardly cover one-third of the medical air transport bill. To make matters worse, the medical air transport cost, even for short distances, sometimes is very high.
Why are Medical Air Transport Costs so High?
Maintaining helicopters and airplanes is no child’s play. It’s an expensive affair. Plus, keeping emergency professionals on standby at all times means additional costs. All these expenses, of course, have to be ultimately borne by the patients availing the services or the health insurance providers. The insurance providers only cover the in-network medical air transport services, and since insurance companies tend to disagree with the high bills that air ambulance companies generate, they only end up covering a part of it. This dissuades these companies to go in-network with the insurance carriers.
There is a Way Out and It Does not Cost Much
All it takes is a bit of planning. When you know well that insurance companies do not cover the expenses fully, exploring other options is the wise thing to do. There are several agencies that specialize in providing medical transport coverage. The costs are nominal and the coverage is usually good. They cover those expenses which are left uncovered by the insurance companies. So, in today’s world while ensuring medical insurance coverage is important, it is equally important to also keep yourself and your family covered for medical air transport emergencies. Failing to do so, can land you in a financial mess that can take years to clean up.
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.
People fly across borders frequently for purposes ranging from recreation to business. One concern that bothers most of these travellers is reaching home safely in case there is a health eventuality. It must be noted that airambulance services can be quite expensive and cost more than $100,000 if you do not have adequate coverage. Yet, people tend to ignore medical flight cost coverage. This happens mainly due to misinformation. Here, we burst a few of such myths.
Airambulance Coverage Comes with Health Insurance Policy
This is the biggest myth that costs most people dearly. While some insurance companies cover a few air ambulance service providers, not all are covered. It is vital that you discuss the kind of coverage that your health insurance policy covers. Look at the coverage both domestically as well as internationally. Also, there is hardly any insurance policy that transfers patients to the hospital of their choice.
Travel Insurance and Air Ambulance Coverage are the Same
There can be nothing which is further from the truth. Travel insurance, unless specifically stated, does not cover air ambulance costs. You might be left to fend for yourself in foreign land where healthcare facilities are not up to your satisfaction. If your travel insurance brings you additional cover for medical flights, go for it. Otherwise, go for an additional cover through another agency.
Coverage for International Air Ambulance is Expensive
There is no truth in this statement. Coverage is often surprisingly cheap and does not cost more than $100-150. You can even get your entire family covered for an amount like that. Memberships are usually annual which means you’ll have to keep renewing it – a small price to pay if you fly frequently. Note that such coverage is available for both national and international travel.
Coverage through Credit Cards is Enough
Does your credit card take you to the nearest appropriate facility only or does it take you to the facility of your choice? Are you expected to make the arrangement for air ambulance? What distance is covered? These are just a few of the questions that you need to ask before solely relying on credit card air evacuation coverage.
If you have more questions regarding airambulance coverage, feel free to ask your questions in the comment section below. We’d love to allay your concerns.
Imagine being in a situation where your loved one has a serious health condition that necessitates use of an air ambulance service and you are left worrying about the cost of utilizing it. No one would want to be in a situation like this. But what if the air ambulance service that you choose offers to help you with the insurance? Yes, there are air ambulance companies out there that will aid you in getting adequate insurance reimbursements. They even hire qualified personnel for this specific purpose. These experts can even give you an idea whether your claim is likely to be accepted or rejected.
Medical Necessity for Air Ambulance Service
There is no denying that the medical necessity for using air ambulance service needs to be established first. How do you achieve that? Well, frankly speaking, it is not in your hands. The physician treating the patient will determine whether the patient needs air ambulance service or not.
If the treating physician deems the use of air ambulance service a medical necessity, will that mean you will get insurance cover? Well, not always. There is the medical director of the insurance company that comes into picture. It is in the right of the medical director to dispute the claims of medical necessity by the treating doctor. If he or she does so, the insurance cover may be denied. However, if you are in good hands, the air ambulance service may try to pursue the insurance reimbursement until the end.
What if the Efforts of the Air Ambulance Company Fail?
That’s a very unfortunate circumstance but not unheard of. If your insurance provider refuses payment and you do not have an air ambulance membership, you might be asked to pay the amount out of pocket. However, most air ambulance service providers offer discounts in such circumstances. You need to be ready to negotiate hard so that you end up paying the minimum.
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.
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.
If you felt the medical situation warranted the air ambulance trip, yet Medicare refused to cover the charges, you don’t necessarily have to be disheartened. You can still check a few things and appeal Medicare to cover the air ambulance expenses.
Check Your Paperwork and Medicare Summary Notice (MSN)
Medicare gives you the reason for not covering air ambulance trip and there can be two primary reasons for it:
- The air ambulance company failed to appropriately document your need for air ambulance transport: In a situation like this, contact the doctor or social worker who was involved in mandating the air ambulance transport. Send this information to the organization that handles your medical bills on behalf of Medicare.
- The air ambulance company failed to file appropriate paperwork: You can always ask your air ambulance company to re-file your claim. If this does not yield results, you can then proceed to file an appeal.
If Medicare Still Refuses to Pay, File an Appeal
People who have Medicare have certain rights and one such right is filing an appeal against non-coverage of your air ambulance bills. Here’s a stepwise approach:
Look at MSN and find reason for not covering the air ambulance trip: Apart from the reason, the MSN will also let you know the time by which you need to file the appeal.
- Follow the instructions on MSN to file the appeal against non-coverage of air ambulance trip: It will also contain the address to which you need to send the appeal. You must accompany it with a letter stating why your air ambulance trip must be covered.
- Get in touch with the doctor who suggested air ambulance services: Attach this information to the MSN before sending it to the designated address.
- Keep a copy for yourself: You might need the copy of your appeal as a proof, so make a copy and keep it with you.
You can also get in touch with Medicare at 1-800-MEDICARE or visit www.medicare.gov/appeals.