High prices of air ambulance towers are difficult to regulate



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In many rural areas, helicopters are the only fast way to get patients to a trauma center or burn unit in the hospital. With the closure of more than 100 rural hospitals in the United States since 2010, the need for air travel has grown.

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In many rural areas, helicopters are the only fast way to get patients to a trauma center or burn unit in the hospital. With the closure of more than 100 rural hospitals in the United States since 2010, the need for air travel has grown.

Ollo / Getty Images

In April 2018, 9-year-old Christian Bolling was hiking with his parents and sister in the Blue Ridge Mountains, Virginia, near their home in Roanoke. While climbing rocks, he lost his foot and fell into a 20-foot rock fall, fracturing the two bones of the left lower leg, the wrist, both sides of the nose and the skull.

A rescue team took him out of the woods and a helicopter took him to a trauma unit at the Roanoke Pediatric Hospital.

Most of Christian's care was covered by the insurance of his parents. But a bill stands out. Med-Trans, the air ambulance company, was not part of the family's health care network and charged $ 36,000 for the 34-kilometer ride from the mountain to the hospital. It was more than the cost of her two-day hospitalization, her scans and her casting combined.

"At that time, you only think about your child's life," said Christian's mother, Cynthia Bolling, occupational therapist. "I know that I'm taking advantage of … it's just wrong."

The growing number of unanticipated medical bill complaints is pushing the Capitol and the White House to redouble their efforts to help consumers. Time and time again, the high costs associated with air ambulance services provide patients with the biggest sticker shock: the subject has been addressed at almost every Capitol Hill hearing and press conference on medical bills. surprises.

Yet air ambulance costs are not addressed in any of the proposals introduced or circulating in Congress. Even a decision taken by Congress last year to set up a committee to study the billing of air ambulances has not succeeded.

"We do a disservice to patients if we protect them against hospital bills but we bankrupt them," said James Gelfand, senior vice president of health policy for the Ontario Health and Safety Committee. ERISA industry, a professional association of large employers.

The issue was again raised on Wednesday during a hearing of the House Energy and Commerce Subcommittee, during which Rick Sherlock, President and CEO of the Air Medical Services Association (the group air ambulance), was among eight witnesses.

Representative Ben Ray Luján, D-NM, urged Sherlock why the costs of air ambulance services had increased by 300% since 2006.

"I'm trying to understand why it's so expensive and why so many of my constituents are being hit by surprise bills," Luján said.

Sherlock explained that Medicare and Medicaid reimbursements do not cover the cost of the services provided. Thus, the fees charged to private patients, he told legislators, must compensate for this difference.

According to industry data, air ambulances serve more than 550,000 patients a year. In many rural areas, air ambulances are the only fast way to get patients to trauma centers and burn units. With the closure of more than 100 rural hospitals in the United States since 2010, the need for air services has increased.

More than 80 million people can travel to a Level 1 or 2 trauma center in just one hour if they are flying a helicopter, according to Sherlock.

The service, however, has a cost. According to a recent report from the Government Accountability Office, two-thirds of the more than 34,000 air ambulance transports examined were not part of the patient's insurance networks. This can leave patients struggling with fees that their insurers do not cover, a practice known as pay billing.

In 2017, GAO found that the median price charged nationally by air ambulance providers was around $ 36,400 for helicopter trips and even higher for other aircraft. The total usually includes the costs of transportation and medical care on board the aircraft.

In addition, NPR and Kaiser Health News' Bill of the Month survey series received more than a dozen bills of this type, ranging from $ 28,000 to $ 97,000.

Cynthia Bolling says her insurance company paid about a third of Christian's bill for air ambulances. The family moved in this week with Med-Trans, agreeing to pay $ 4,400.

Reid Vogel, director of marketing and communications for Med-Trans, said he could not discuss the case of a patient because of the rules of confidentiality. But, he adds, Med-Trans works with patients to find "equitable solutions" when their bills are not covered by insurance.

With almost three-quarters of flights going to low-paying Medicare, Tricare and Medicaid patients, "providers need to transfer costs to insured patients".

Private insurers, however, generally only pay an amount close to that paid by Medicare, or about $ 6,500. This encourages air ambulance companies to stay out of the network, according to a 2017 GAO report.

"A representative from a large independent provider indicated that not benefiting from insurance with the network was advantageous to the provider because a patient receiving a balance invoice will require a higher payment to the provider. insurance company, which often results in a higher payment from the air ambulance provider than having a pre-negotiated payment rate with the insurer, "GAO said in its report.

Sherlock, of the Airline's trade association, disputes the report's findings, saying its members are actively trying to network in more places, though it can not provide accurate numbers. .

"I think wherever they can, they are encouraged to be part of a network," he says.

States are hampered in their efforts to ease the burden on residents.

The 1978 Deregulation of Airlines Act, which was intended to encourage more competition, prohibits states from regulating the prices of any air carrier, including air ambulances. In addition, many employers' health insurance is not governed by states, but by federal labor law, known as ERISA.

So a cure probably has to come from Congress. And it turned out to be a heavy lift.

For example, the committees responsible for regulating the airline industry – the Senate Committee on Commerce and the Transportation Committee in the House – do not define a health policy or regulate health insurance.

Last year, some lawmakers attempted to let states regulate air ambulances through a provision of the bill again authorizing the Federal Aviation Administration.

But this measure was finally eliminated. Instead, the bill provided for the creation of an advisory committee to study the prices of air ambulances and unexpected bills.

"The air ambulance lobby has done a very good job as a defender when authorized by the FAA," Gelfand said.

The committee, which was to be formed within 60 days of the effective date of the law – October 5, 2018 – has still not been created.

Representatives of the air ambulance industry do not think that a congressional action is necessary, although they are asking for a higher reimbursement of Medicare.

Chris Eastlee, vice president of government relations at the Air Medical Services Association, said his group did not want more price regulation by Congress, but would support mandatory disclosure of costs to the secretary of the Department of Air Services. health and social services. Greater transparency, according to the Eastlee Group, will help companies negotiate more contracts in the network.

A solution for surprise bills that is supported by some researchers and advocates would require every health care provider in a medical facility to accept any contractor insurance plan with that hospital. It could also help reduce air ambulance bills, says Loren Adler, Associate Director of the USC-Brookings Schaeffer Initiative for Health Policy.

This would avoid the case where someone chooses a network hospital to discover that a surgeon or anesthesiologist at this hospital is not taking insurance from the patient. Air transport should also be included in the rule, says Adler.

"It's exactly the same situation as for off-grid emergency facility rates," Adler said. "The same solutions should apply."

Gelfand also suggests that the House Ways and Means Committee asks air ambulance companies seeking to participate in Medicare to always charge the network rates.

It would only require a small adjustment of the legislative language, as conceived by Gelfand. "Every proposal that includes something to deal with surprise bills for emergency care, all you [would] The words "air ambulances" must be added, "he says.

At present, the Bill on Medical Costs of Senator Lamar Alexander, and Senator Patty Murray, and Senator Patty Murray, is the bill on medical costs that has the greatest impact. importance for air ambulances.

Their plan would require air ambulance bills to be detailed to reflect both medical and transportation costs – so that patients and health plans can understand them better.

Kaiser Health News is a non-profit, editorial independent program of the Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente.

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