COVERAGE WHEN IT COUNTS

Across America, patients are facing burdensome bills for medical care that was critical to their health or even saving their life. Whether its drug prices, the cost of emergency room visits or pre-existing conditions, patients are often stuck in the middle between providers of care and how to pay for these services. While these issues are complex, and the solutions challenging, it’s clear that one industry in particular needs to do more for patients across the health care system – private insurers. Consumers who pay monthly premiums for insurance deserve to know they’ll have coverage when they need it the most.

To this effect, SOAR has launched Coverage When It Counts,” a campaign that asks the question:

“What’s the point of insurance, if it doesn’t cover emergency health care when you need it the most?”

Private insurers must be held accountable for not adequately covering emergency care. While many private insurers are good actors and are working with providers to pay at or close to full bill charges, some private insurers are setting rates that are not reflective of true costs, then shifting those costs to patients. There are several tactics some private insurers utilize in order to maintain their own profit margins:

Deeming Care Not “Medically-Necessary”: When private insurers under-reimburse patients for air medical transport, or any other medical service, they often do so under the guise that the transport was not “medically-necessary.” Sometimes they deny claims from their patients after the medical transport, leaving patients to cover the bill themselves. This is despite the fact that air ambulances don’t self-dispatch and are only called to the scene of a health emergency when a trained first responder or doctor deems it critical to the patient’s health – because time can make all the difference during an emergency. Private insurers should stop playing doctor and cover care that a physician said was necessary.

Refusal to Go In-Network With Providers: Along with presuming care is not “medically-necessary,” for too long private insurers have pursued narrow networks in order to reduce their costs and maintain profit margins. And it’s working – UnitedHealth Group, for example, says 2019 revenues will bypass $240 Billion. But at what cost? The patients.

The fact is emergency air medical transport can be covered by private insurance for a small increase in premium. A Montana legislative study found that for only $1.70 a month more in premium, air ambulance services would be covered.  A similar study in Kentucky estimated that the increase would be between $0.92 and $3.69 per person per month.

While some good actors within the industry strive to work with providers to bring services in-network, others refuse to negotiate in good faith and keep their networks narrow so they don’t have to cover certain services. Air medical companies, as well as other medical providers, have patient advocate teams whose sole function is to advocate on the patient’s behalf and exhaust every avenue to get coverage from their insurance carrier. That shouldn’t be necessary, and wouldn’t be, if insurers did right by patients.

The SOAR Campaign is calling for insurers to work with air medical providers to go in-network and reimburse for these life-saving services. It’s the right thing to do.

Reach out to your private insurer and urge them to fully cover air ambulance services.