The year 2021 is behind us, and as we enter the brand-new year, we look at it with a lot of hope. The year gone by was quite eventful for the air ambulance industry, to say the least. The pandemic continued into the second year, and by the looks of it, is going to bother the world in the years to come. However, there was a silver lining. The latest variant, Omicron, although considered highly transmissible is less lethal, especially when compared to the previous variant, Delta.
Then, there was the issue of balance billing, which brought a lot of negative public perceptions towards the air ambulance industry. It had created a constant tussle between the health insurance industry and the air ambulance industry. The result was the No Surprises Bill – effective January 2022.
Customer Expectations in 2022 from the Air Ambulance Industry
One major expectation will be to utilize air ambulance services without the worry of having to bear the balance payments. Payment will now be a matter that needs to be sorted out between insurance providers and the air ambulance industry.
Rural America can possibly breathe free of the worries about the Coronavirus given the fact that air ambulance service will now be much more reachable due to the No Surprises Bill. Of course, it is yet to be seen how much of the air ambulance industry will be willing to support rural areas. The reason: with the insurance companies prefixing costs, the medical flight providers might witness dwindling margins and diminishing motive to serve far-off regions.
Differences Need to be Ironed Out in 2022
Overall, it can be said that the air ambulance industry is moving in the right direction from the customers’ point of view. If all outstanding issues are sorted out, it will be highly beneficial to all parties involved. Perhaps, the government needs to play a more active role as an arbitrator.
As the year 2021 draws to a close, the No Surprise Bill will make its way. Soon, it will be illegal to charge patients for medical flight services availed during emergencies. However, there are several groups that are opposing this change vehemently. What does it actually mean to the common man? Will there be a compromise in care due to the bill? These are some of the questions that are bothering several people across the United States. In this context, it is not just some players involved in medical flight services who are opposing this bill, there are several medical practitioners too who have joined the chorus.
Not Just Medical Flight Services
It is not only the medical flight services that will be included in the No Surprise Bill but also medical care in general. Medical scans, lab tests, consultations, treatment, etc., too will come under this bill. The common man would be completely insulated from being responsible for bearing such medical expenses. Instead, it will be a matter that has to be sorted between the service providers and the insurance companies. Experts say that, on its part, the insurance company has already come up with standard payments for certain services. This move has been a thorn that has bothered medical professionals.
Private-Equity-Based Care Will Bear the Brunt of It
There are several for-profit organizations out there that literally compel people to opt for services that come under particular insurance networks, failing this, the patient would be liable to make the balance payments that the insurance does not cover. This is set to change with the bill which will come into effect from January 2022. The insurance payments too are slated to come down, which means that the United States will see some cooling off when it comes to healthcare costs in general. Currently, US healthcare costs are among the highest in the world.
Insurance coverage denials have long troubled patients, especially when they avail of air ambulance services based on the suggestions of treating physicians. It must be noted that any patient who is in a serious medical condition cannot deny air ambulance transport surpassing the suggestion by the treating physician. The situation has caused many instances where the cost burden is ultimately transferred to the patient when the insurance company denies coverage. This time around, it was a patient who was suggested to fly to a level 1 trauma hospital in Florida. He was on a cruise at the time, and he had suffered a myocardial infarction.
The Insurance Company Had Suggested Against Using Air Ambulance Service
Insurance companies usually suggest that patients are brought to the nearest appropriate treating facility, else the coverage is denied. However, it is the insurance company that decides the appropriateness of the treating facility. In this case, the treating physician had suggested a facility in Florida whereas the insurance company had suggested a nearby hospital. Despite what the insurance provider had said, the patient was flown to Florida. This was the reason why his insurance coverage was denied. In response to this, the patient has now sued the insurance company.
The Air Ambulance Bill Came up to USD 240,000
An air ambulance bill that runs into huge amounts, such as the one received by the patient in question, can run anyone into bankruptcy. The reason cited for denial was that the advice of the insurance provider was not heeded. The hospital expenses and the land ambulance cost were covered but not the air ambulance service.
The lawsuit was filed on the 6th of October by the patient and names the insurance company for denying the coverage. He believes that the insurance provider had wrongly tried to force him to avail of a medical facility that was not in his best interest.
Infections even after COVID-19 vaccinations are rare but not unheard of. Moreover, the world is today witness to newer variants of the virus and no one knows for sure where the mutations are headed. In this scenario, owing the right medical insurance is of utmost importance. It is every individual’s responsibility to understand what is covered under the insurance and what is not, especially when it comes to medical flight services. Finding out that you have inadequate coverage at the very last moment when you need a medical flight can be disastrous, especially since the cost can veer you towards bankruptcy.
Coverage for Medical Flight Services
Adequate medical flight insurance coverage is especially important for those who travel overseas. Of course, it goes without saying that a comprehensive travel insurance is important. However, not many people understand the importance of looking into the fine print about whether medical flight evacuations are covered or not. If covered, what is the kind of coverage that you would be getting. One must keep in mind that international medical flight evacuations can be extremely expensive and can run into several thousand dollars, often running into eight-digit bills.
What Coverage do you Need?
Some travel insurances will only offer to admit you to the nearest adequate medical facility. That means that you might end up with the best possible treatment but in a developing country or an underdeveloped country. On the other hand, if your insurance promises that you will get treatment closer to your home in your nation, it may necessitate a medical flight evacuation. What you want is a health insurance policy like that. The premium may be slightly higher, but you can breathe a sigh of relief and travel confidently to any corner of the globe. This is especially important in the context that much of the world remains without access to COVID-19 vaccination.
Here is some food for thought – ever wondered how many missions are spread around the world? According to a 2017 statistic, the number stands at 430 thousand. Close to 50 thousand of them around from the United States. These people do good work around the world helping people with education to healthcare. What happens when these missionaries get sick or are gravely injured? You guessed it right. Air ambulance services come to their rescue and fly them back to their home in the United States. Most of these missionaries work in the remotest parts of the African continent where healthcare can be less than adequate.
The Cost of International Air Ambulance Services Can Be Steep
The air ambulance cost can go up to 100 thousand dollars. Missionaries, of course, are compelled to rely on fund-raising efforts in order to be able to afford these air ambulance services. A Tampa-based company has changed this scenario to a very large extent. The air ambulance company specializes in offering international evacuation services specifically for missionaries. Not just that, the company has gone a step ahead and created customized insurances for evacuating missionaries from all over the world.
The Name of the Air Ambulance Company is Jet ICU
Almost all missions that are conducted by this air ambulance company involve missionaries across the world. There is no corner of the world that it hesitates to travel. Of course, it has also conducted evacuations of people who are not missionaries. The company owns a fleet of six fixed-wing aircraft and an employee pool of around 75. The customized insurance that the company has tried up with is called Missionary Travel Association, through the help of Lloyd’s of London. Most of the churches today across the United States rely on it today.
Although the congressional bill that seeks to ban surprise billing is not limited to the medical flight industry, much has been made out about it. The bill will span the entire medical industry including doctors and medical service providers. Since the bill is Federal, it will apply to the medical flight industry too. However, this long-drawn bill was seen as a battleground with insurance providers on one side and the rest of the medical fraternity on the other. Who won the battle? This was the question that most people were asking at the end of it all.
It was a Balanced Bill with No Defeats
The main source of contention was the fixing of prices for various medical services. The insurance industry was bent on fixing it according to their prevailing rates, which, frankly, were outdated. On the other hand, the medical fraternity, including the air ambulance industry, wanted the government to consider its price list. However, it was widely believed that the list consisted of highly inflated prices. Realistically, it was never expected to be accepted even by those who were advocating it. The congressional bill has skilfully navigated between the industries to ensure that all involved parties get a fair deal.
Medical Flight Services Get the Option for Arbitration
The dispute about medical flight bills has always been between the insurance and the air ambulance industry. However, common citizens have borne the brunt of it. Now, however, the bill will introduce a mechanism for arbitration between the two parties so that they can sort it between themselves and leave the patients out of it. This will ensure that no patient gets a surprise medical flight bill even if the provider is out of network. The bill goes on to suggest protection for those without insurance too, in case of health emergencies. The way forward, it seems, is coming to a consensus for both industries.
The air ambulance industry, for the most part, had been opposed to the recently passed bill by Congress that seeks to put an end to surprise billing practices. The state governments in the United States have been on a long and hard-fought quest to curb surprise billing practices. However, since the air ambulance industry is protected by federal law, states were helpless in controlling their billing practices. This fact has now changed and brought along new challenges for the air ambulance industry. Most of the players in the medical flight industry are private-equity based and have largely remained out of insurance networks. The new bill can hit them hard.
Effect on the Air Ambulance Industry
Maintaining air ambulance services is no small task. From maintaining the aircraft and hangars to paying off highly experienced and qualified personnel, the costs are high. So far, the costs were covered well as the discretion to bill their services had no curbs. Now, with the new bill, the air ambulance companies will have to make do with what the insurance companies approve. Failing to agree on the pricing will only lead them to an arbitrator whose decision will be final.
What Can the Air Ambulance Industry do?
It goes without saying that profits will dwindle down. However, as most air ambulance companies have already begun doing, it makes sense to join insurance networks. This will ease the payment process. Also, it is time that the industry looks at quality services wherein patients voluntarily opt for their services, even if it means that they will need to pay an out-of-pocket premium. The air ambulance industry now needs to veer its attention towards brand building activities. In this context, it must be noted that the service providers are still not compelled to limit their bills. The only change is that patients will no longer be liable to pay balance bills unless they opt to do so.
A bill concerning the surprise billing practices of the medical flight industry might bring a solution soon. The insurance companies and the medical flight industry have been in the midst of a heavily fought battle around this. Both parties have time and again blamed each other for the high air ambulance bills that patients receive. Such developments have also resulted in bad press for both the players. However, bringing the air ambulance industry to compromise on its billing practices has so far seemed impossible. This is mainly because the states have little control over them and the Federal Government has been sitting over it for quite some time.
The COVID-19 Situation and the Medical Flight Bill
The COVID-19 pandemic had definitely delayed the passage of any bill related to surprise billing practices of the medical flight industry. However, it now seems that it may be passed along with the COVID-19 relief bill. Politicians have intervened to get both parties to find a middle ground, but it has largely been unsuccessful. Both the industries have not budged from their stand but it must be noted that most medical flight service providers have tried to get into insurance networks in recent times.
What Will the Bill Do?
The Federal bill will prohibit medical flight service providers from charging the patients directly for their services in the event that they are out of the patient’s insurance network. This is mainly being done as any patient, during critical times, has no time to contemplate the choices. On the question as to what would happen when a patient wilfully chooses an out-of-network medical flight, he or she might have to pay out of pocket, but there are restrictions. The medical flight service provider can only charge the patient if the patient is given 72 hours to analyze the costs. The patient’s consent to use the services in such instances is also important. If the bill goes through, it could change the landscape of the medical flight industry.
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.