A recent issue of MyHealthGuide newsletter has put the spotlight on air ambulance regulation. In fact, the Health Care Administrators Association (HCAA) and Society of Professional Benefit Administrators (SPBA) recently initiated a targeted letter-writing campaign focuses on rising air ambulance transportation costs for self-funded health plans.
Without reform, America’s families, health care providers and the self-funded community face an increasing and often conflicting set of rules and regulations that fail to provide any semblance of financial certainty when life-saving air ambulance services are employed.
– HCAA and SPBA
Air ambulances are typically covered by health insurance if determined to be medically necessary, and if the service is limited to the nearest appropriate medical facility. Fees are generally not covered if the air ambulance is used solely for convenience. Almost all air ambulance services are out of network, and since the service must typically be arranged under urgent circumstances,any pre-service negotiation is rarely an option.
At ASG, we’ve seen first-hand instances in which air ambulance charges have skyrocketed into outrageous dollar amounts, especially when used in urgent situations and provided by non-network vendors, oftentimes without precertification. Many times a deposit is requested from the patient/family and without a signed negotiation the member is balanced billed.
For example, we recently worked with a claimant who had an accident in Georgia and was hospitalized there, but needed a specialized rehab facility for recovery. We soon learned there are only fourteen such facilities in the country; the closest location was quoting a three-week waiting period; and due to the woman’s condition, air transport was the only option to get the claimant to any of the other thirteen. On top of these obstacles, the employer group’s plan did not require a precertification for the service.
The claimant was ultimately transported from Atlanta to a rehab center in Chicago. The air ambulance bill: $258,000. Thankfully we were able to negotiate the claim to $136,000, even though the air ambulance company was pushing for immediate payment.
These numbers are not unexpected. A recent study conducted by the Montana Legislature broke down air ambulance costs into two main parts: liftoff fees and per-mile charges. While the former ranges between $8,500 to $15,200, the latter can be anywhere from $26 to $133 per mile. These variable charges are based on distance and staffing needed for the transport.
We and others in our industry are keeping a close eye on Sentinel Air Medical Alliance, an alliance of healthcare payors established in response to the rapid escalation of air medical transport rates. Sentinel's goal is to provide solutions for effectively controlling rates and ensuring proper utilization of air transport services. The alliance's areas of focus include prior authorization for air ambulance services, medical review of transport claims, claim negotiating and repricing, and consulting services to help healthcare payors develop strategies to control air ambulance costs.
Global Emergency Services provided by Assist America are included with every ASG sold stop loss policy. These services are a supplement to the health plan
but it is imperative to contact them to make arrangements such as air ambulance as they cannot reimburse for arrangements made by another party. For
more information on Global Emergency Services go to http://www.assistamerica.