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.
Healthcare costs are not just about air ambulance costs. The United States of America has one of the highest healthcare costs in the entire world. An average American spends over 10 thousand USD in a year and the nation spends 3.3 trillion USD each year. This amounts to about 18 percent of the country’s GDP. Let alone the need for an air ambulance, a simple emergency room visit can leave a foreign national in huge debt. Hospitals simply do not release patients unless the care debts are paid out in full. A scenario like this can quickly turn a fun vacation into a financial nightmare, leaving the patient bankrupt.
A New Legislation May Necessitate Insurance
Although the legislation is primarily targeted towards immigrants to the nation, it is not entirely clear whether it applies to visitors to the nation as well. According to the new law, immigrants will have to purchase insurance for a period of 365 days or until such time that they stay in the country, whichever comes earlier. The move is meant to insulate the country from bearing high healthcare costs. In the face of this uncertainty, experts recommend that, regardless of the regulation, visitors must opt for comprehensive insurance.
A Policy that Covers Air Ambulance Services is Ideal
Not all visitors to the country arrive without insurance. However, many of them do not opt for adequate coverage. A slightly expensive premium can offer comprehensive coverage. Here is a scenario: you embark on a cruise during your visit. Unfortunately, you end up having a stroke. You will need to be flown to the nearest appropriate medical facility via an air ambulance service. The cost of this transport is going to cost quite a lot. The wise thing to do, therefore, is to explicitly ask your insurance provider about air ambulance coverage to stay safe.
There’s a lot happening in the air medical transport industry currently. With the state lawmakers and the feds trying hard to end surprise air medical billing practices, there is a high degree of lobbying that is taking place both by insurance and air medical transport industry. There is a huge amount of blame game going on. Both parties are trying to pin the blame on each other. Often, you’ll find articles that highlight high bills that patients are compelled to foot and on the other hand, articles that detail the plight of the air ambulance industry and the rising costs it is grappling with.
What is a Surprise Air Medical Transport Bill?
In order to understand what surprise air medical transport bill is, we should adopt an industry agnostic perspective. The problem is not just with the air ambulance industry, it is rampant throughout the medical world. In the United States, unlike other parts of the world, insurance is a matter of network coverage. If a provider is not covered by the insurance company, it is likely that the reimbursement is going to be rejected. This compels the patients to foot the bill all by themselves. This phenomenon, where a person is compelled to pay a medical bill, in spite of having medical insurance, is known as surprise bill. This is what the polity of the nation is currently trying to eliminate.
Why is Tough to Eliminate Surprise Billing?
There are several facets to this. Some air ambulance companies, in the absence of fair reimbursement by insurance industry, simply do not want to come in network. The question arises, “Why?” The answer is obvious – this move paves the way for balance billing where the patient becomes responsible to foot that cost which is not covered by the insurance provider. Then who is to blame? Well, both insurance and air ambulance industries: the insurance industry because it refuses to reimburse a fair amount and the air medical transport industry because it refuses to come within insurance networks. It’s a Catch-22 situation.
Travel insurance is the safety net that you need when travelling abroad, especially in countries where the quality of health care is not the same as the one you enjoy in your home country. In such situations, air ambulance can become an absolute necessity. Most people assume that travel insurances automatically ensure an air ambulance to their home countries if they felt there is a necessity and that it is the patients’ choice to get the treatment wherever they desire; however, these beliefs are far from true. The insurance company can actually deny a claim and for the patient to get treatment in the visiting country. The company would weigh the cost advantage in situations like these.
Checks Air Ambulance Cover Before Purchasing the Travel Insurance
Explore as many travel insurance options as you can before zeroing down on a specific one. Reveal upfront the kind of activities you plan to indulge in and check out the premiums. If you have any pre-existing illness, make that known clearly and check out the premiums. The fear of higher premiums must not deter you from making this revelation as you can get into a huge financial mess owing to this mistake later.
Know Your Coverage Well
Also, some activities are considered very high risk and certain travel insurance policies might not cover them. If you’re going to be a part of some extreme adventure event, check out the facilities that the organizers offer and also whether the insurance company is willing to cover the mishaps that occur during such activities.
There have been several instances in the recent past where the travelers have not bothered to look closely enough whether the insurance company covers air ambulance services and later have had to resort to crowd funding to afford international air ambulance services. A little homework can avoid such issues and make your travel more secure and safe.
‘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.
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.
While medical air transport is, no doubt, a life-saving necessity, the bills that the service generates can be quite shocking in most instances. The one belief that lands people in a financial mess is that having a medical insurance is enough to cover the medical air transport bill. Nothing could be far from reality. Insurance companies usually have a tie-up with only a few air ambulance companies. The rest of the companies are considered “out of network” by these insurance providers. What makes it worse is that medical emergencies do not always allow people to choose the in-network companies. When it’s a question of life and death, the quickest service is always the first priority.
Medical Air Transport Requirements are Real – Plan Them
“Prevention is better than cure” and this saying holds true for medical air transport planning. People need to get out of denial thinking, “Oh, that’s a farfetched requirement for me.” Memberships are offered by most air ambulance companies at a very reasonable price. Availing these is the wisest thing you can do.
What if You Do Not Have Air Ambulance Coverage or Membership?
Let’s consider a scenario where you end up with a huge medical air transport bill and you’re absolutely unable to pay it; plus your health insurance refuses to cover it. Get in touch with the air ambulance company, tell them your financial status and make it clear to them what you can pay. Most companies will agree to what you can pay (or at least a figure close to it). The reason is simple – a smaller payment is better than no payment at all.
You can request them for a payment plan, if you think you can pay it over a period of time. Also, negotiate with your health insurance company and try to get them to pay more. Do not shy away from taking legal opinion if it comes to that.
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.