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.
We have seen far too many medical air services bills going unapproved by insurance carriers. It is sometimes hard to point a finger whether the insurance companies should be held responsible for payment or the medical air services. The state of North Dakota, however, has been trying hard to pass a legislation that ensures the burden is off the shoulders of the patients. However, medical air services seem to be up in arms against this legislation, and they seem to be making a valid point. Here, we look into this law and also the factors that are preventing its implementation.
Medical Air Services and Insurance
People who are not a part of Blue Cross Blue Shield are often left to fend for themselves when a huge medical air services bill comes knocking on their door. The reason is simple: most private insurance carriers do not cover the full air ambulance bills and only pay a part. Also if an air ambulance company is not a participating provider of your particular insurance provider, you might have to bear most of the costs yourself. But choosing the participating medical air services is not always possible when life is at stake.
The Government of North Dakota has realized this and is trying to force medical air services to become participating providers with all major insurance companies. The legislation also is trying to set cost limits, where the air ambulance companies cannot charge more than the upper limit set with the insurance providers.
Medical Air Services are Against the Legislation
Federal laws state that states cannot regulate medical air services. Certain air ambulance companies are vehemently opposing this legislation stating that the law would amount to interference that is beyond the purview of the state governments. In fact Valley Air Med has openly challenged this legislation in US District Court in Bismarck. The US Department of Transportation too seems to be siding Valley Air Med’s argument as it feels medical air services should only be guided by federal laws.
As things stand currently, Valley Med Flight has become a participating provider but has voiced its dissatisfaction with Blue Cross Blue Shield payments.