PA Seeks Increased Payer Coverage of Emergency Air Ambulances

April 25, 2017 - Emergency air ambulances save lives, but they can also leave patients in a mountain of debt.  Pennsylvania Insurance Commissioner Teresa Miller would like payers to shoulder more of the costs of these critical services, and has accordingly voiced her support for proposed federal legislation that would increase transparency and regulate coverage of emergency air transportation.

The proposed Isla Rose Life Flight Act, sponsored by Senator Jon Tester of Montana, would allow states to “enact or enforce a law, regulation, or other provision having the force and effect of law relating to network participation, reimbursement and balance billing, or transparency for an air carrier that provides air ambulance service.”

Under the Airline Deregulation Act (ADA) of 1978, state’s currently lack the authority to regulate the emergency air ambulance services. 

"I have heard from consumers as well as state legislators about the problem of air ambulances not affiliated with a hospital, and not in an insurer's network. Air ambulances, by their very nature, are transporting a patient in an emergency situation," wrote Miller. "The consumer has no choice over what air ambulance service is used to get them or their loved one to a facility that can provide the care needed as quickly as possible.”

The average cost for air ambulance service runs over $40,000, and is not always covered by payers. 

"I heard from a patient involved in a car crash that rendered him unconscious. The individual, while unconscious, was flown by air ambulance to a trauma center. His insurer is refusing to pay, claiming the situation was 'not life threatening,' leaving this person, who obviously had no say in this transport, with a $40,000 bill," wrote Miller in the letter.  

Miller also recalled a patient who had a large brain tumor and required immediate surgery.  This resulted in an air ambulance bill of $47,759, of which a payer covered $10,675 because the air ambulance was out-of-network.  In that case, there was no in-network air ambulance service covered by the provider.

Pennsylvania Rep. Tina Pickett (R), Chairman of the House Insurance Committee, led a recent meeting that discussed issues related to air ambulance billing, such as low CMS reimbursement rates and the effect of the costs on health insurance premiums.

Pickett joined her state insurance commissioner in a call for change and regulation in the air ambulance industry. “States like Pennsylvania need to have more say in this industry, especially in terms of transparency of cost and protocols for using the service, to protect the consumer who may not have a choice in transportation to a hospital or trauma center,” said Pickett.

Pickett also cited constituents with bills over $30,000 that had claims denied or only partially paid by insurers, leaving them with no recourse for the balance.

“Under current federal rules, states cannot control costs, routes or services, and I am hopeful that this federal effort passes." 

According to Miller, Pennsylvania is currently working on a bipartisan bill that would protect residents from surprise balance bills delivered by facilities and healthcare providers.  Even if the state bill passed, Miller noted that without federal legislation such as SR 471, that the ability to engage in any form of air ambulance regulation would be off limits.

"We must find a way to protect consumers from experiencing these crippling bills at such vulnerable times in their lives. And as we work to contain the cost of health care, air ambulances must not be overlooked," said Miller.  "These vital services save lives but must be affordable to the consumers who need them. SR 471 would allow states to decide how best to regulate the price and services of air ambulances, and protect consumers."