The air ambulance industry and the insurance industry will soon be coming to a point of intersection as surprise billing practices will come to an end in less than a year in the United States. There has been great public support for this move by the government. The states that were, so far, unable to regulate the air ambulance companies owing to certain federal laws are now assured that prices can be brought under control. At the outset, it seems that everything will go well in the days to come. However, it is important that people look at both sides of the coin and weigh the cons too. Let’s take a look at some of them and the impact they can have on the people.
Private Air Ambulance Companies May Pull Back
While the lawmakers have been enthusiastic in forming the bill to end surprising bills, it must be noted that their involvement in providing air ambulance services to people has been next to nil. In an attempt to appease the masses, they may be shooing away new entrants to the air ambulance market. The United States, unlike countries like the United Kingdom, depend hugely on private players to keep the air ambulances flying. In this context, it must be noted that costs are must cheaper in the United Kingdom, owing to the fact that these companies are mostly charity based. Their funding mostly comes from corporates, the government and the local communities.
The Rural United States May Suffer
An air ambulance company that runs the least number of flights is usually the most expensive. The reason being the cost of maintenance is distributed among a small customer base. This is often the case with rural areas where the population is thin and the demand for air ambulance services is low. If the prices are standardized, air ambulance companies may be discouraged to serve such regions. For the rural United States, which is already suffering from a choppy medical infrastructure, it is not good news.
It is widely believed that the new air ambulance regulation that is aimed at putting curbs to surprising billing practices will come into effect at the beginning of the next year. What it holds for the common man is a mystery to much of the country at this point in time. Most people believe that it will put an end to the unexcepted huge medical and air ambulance bills. While this is true to a very large extent, it is not the entire story. There is more to it. We try and highlight those points that one must know fully.
Air Ambulance Billing Can Be an Individual Choice
You will always be encouraged to take an in-network air ambulance service. The cost will be a concern only for the insurance and medical flight service providers. But what if you want an air ambulance service that is out of your network? Upon giving written consent, you can opt for any medical service that you choose. However, the insurance company may not cover the full amount and you may have to pay the service provider on your own.
The Coverage May Depend on Your Insurance Plan
Co-payments will remain as previously. The only difference is that the co-pay amount will not change based on the network. The regulation is applicable only when the service is provided by a non-participating service provider in emergency situations. This part of the regulation will come in handy in instances where the patient is not the decision-maker. For instance, the call to avail of an air ambulance service may be taken by the treating medical professional during an emergency. The patient might not even be able to give consent. The clearance of the resultant bill does not come under the responsibility of the patient anymore.
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.
It was not too long ago that news headlines were abuzz with the possibility of ending surprise billing but now, it seems nothing much has changed. The air ambulance industry too was watching the development with much anticipation. What happened to all the efforts surrounding it? If this question has across your mind, you are not alone. Thousands of Americans were hoping that the practice ends, and they can avail healthcare facilities without worrying about insurance coverage. Had the bill been passed, people would have enjoyed seamless coverage despite being in or out of insurance networks. However, this does not seem to be the case anymore. Let’s take a look at what happened.
Are Private Equity Investors to Be Blamed?
There are allegations flying around that big investors ran an aggressive ad campaign to cast doubts on the move to ban surprise billing practices. On the part of the air ambulance industry, it must be noted that several service providers had enrolled themselves with various insurance providers to widen their network – a very welcome move.
Another set of people believe that lobbying against the bill was quite strong. In that, some of the lawmakers, at the end of it, were not very keen on ending the practice. The reason behind this is not entirely clear, though.
Is COVID-119 to be Blamed?
Many industries, including the air ambulance industry, had felt the effects of the COVID-19 pandemic that gripped the world. The increase in cost – owing to extensive sanitization and pandemic protocols – and reduction in demand were just a few of the reasons that put economic pressure on the air ambulance industry. Besides, the availability of medical staff became a big concern. The government too was grappling with ways to combat the unprecedented situation. With so many things weighing in, the will to do away with surprise billing seems to have simply vanished – at least for the time being.
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.