It’s time to address the root cause of balance billing

Air medical services are flying ICU’s, providing life-saving emergency medical care to patients across the country. They are ready to respond on a 24-7-365 basis to requests made by an EMT or attending physician at the scene of a serious accident or other health emergency. Air medical providers never want patients to receive a bill they didn’t expect or cannot afford, and want the root cause of balance billing addressed on the federal level.

Stories about a very small number of patients that have received large balance bills have been made prominent by the media. But the facts about air medical are very different and are critical to understanding and addressing the balance billing issue. For example, the State of Wyoming recently collected data on balance billing by air medical providers, and a different, more accurate picture emerged.

According to the Wyoming Department of Public Health, the vast majority of patients – about 90% – pay nothing at all for an air medical transport. The report found that the average out-of-pocket payment for all emergency air ambulance patients in Wyoming is $300, not the tens of thousands of dollars presented in the media. In other words, while lawmakers are rightly concerned about a few outliers, the data show that the vast majority of patients do not experience balance bills after an air ambulance transport.

Balance bills for air medical services are rare and only occur when a patient’s private insurer refuses to pay for the life-saving service. Thirty percent of all emergency air medical transports are for patients with private insurance, while 70% of air medical patients are either uninsured or covered by Medicare, Medicaid or other government insurance. Unfortunately, when Medicare covers only 59% of the cost of a transport and Medicaid covers only 34% on average, the cost of the air medical system gets shifted to everyone else.

This dynamic is already causing air medical bases to close – 32 have been shuttered since the beginning of this year alone. When bases close, real people lose access to health care in emergencies, especially in rural areas. If insurance doesn’t cover this type of service in an emergency, what is insurance for?

The legislative remedies to balance billing currently under consideration in Congress, while perhaps well intentioned, are misguided. If Section 105 of the Lower Health Care Costs Act passes in the Senate setting reimbursement rates for air ambulances at a "median in-network rate," the closure of air medical bases would accelerate rapidly, leaving Americans in rural areas without access to care when they need it most. Today, because of air medical services, 90% of Americans can reach a Level I or Level II trauma center within an hour. However, since 2010, more than 90 rural hospitals have closed and an estimated 20% more are at risk of closing, putting rural access to emergency care at critical risk.

There is a better way. Last year, Congress passed legislation calling for the U.S. Department of Transportation to collect cost data from the industry and develop recommendations for protecting patients from balance billing. This process must be allowed to move forward before harmful legislation is passed that puts these services at risk.

In addition, Rep. Ben Ray Lujan’s (D-NM) has proposed an amendment to the House Energy and Commerce Committee’s No Surprises Act (HR 3630) which would require the Department of Health and Human Services (HHS) and the Government Accountability Office (GAO) to collect cost data from air medical providers and claims data from insurers, and report to Congress on the overall cost of providing air medical services. The SOAR Campaign applauds this approach as it will allow policy makers to look at real data and address the root cause – denials by private insurers and chronic under-reimbursement by government payers.