By: Matthew Albright, Chief Legislative Affairs Officer, Zelis Healthcare
Shockingly high air ambulance bills have been making the headlines and the horror stories are backed by statistics. The U.S. Government Accountability Office (GAO) released a report in March that found that nearly 70% of all flights taken by insured patients were considered out-of-network, making it much more likely that surprise air ambulance bills would end up being the responsibility of the patients. The GAO further found that the median price charged by air ambulance providers was about $36,000 for a helicopter and $41,000 for a plane − up almost 50% from 2010.
While Congress has generally shied away from dealing with air ambulance billing, they have taken some recent baby steps.
Federal Action on Air Ambulance Billing
State legislatures have struggled to regulate egregious air ambulance billing because states are prohibited from regulating aircraft, including helicopters, under the Airline Deregulation Act (ADA). The ADA prevents states from interfering with routes, services and fares of aircraft, which, for now, includes fees for air ambulances. Earlier attempts by states, including North Carolina and North Dakota, to legislate egregious balance billing have been quashed by lawsuits by the air ambulance companies.
For its part, the U.S. Congress is not keen to take on air ambulance billing directly because the issue would touch on multiple different statutes, and at least three different federal agencies might have to write rules around it. In other words, it’s complicated, and complications are the one thing that lawmakers want to avoid as they try to pass a bipartisan healthcare fix for surprise balance bills before the 2020 elections.
However, in late May 2019, air ambulances were gingerly addressed in the Lower Health Care Costs (LHCC) bill draft, introduced by the Senate Health, Education, Labor, and Pensions (HELP) Committee. Among other healthcare cost-cutting suggestions, the bill requires non-transportation costs of air ambulances (i.e., health care costs) to be split from the transportation costs and directed that the non-transportation costs should not be under FAA authority.
The implication of this cost-splitting is that air ambulance healthcare costs should be governed by HHS or, perhaps, state law, while the transportation fees would remain under FAA’s authority. Splitting the costs might be a simple approach to regulating the healthcare costs of air ambulances, while leaving untouched the underlying FAA statutes.
In order for that to happen, however, the LHCC Act would have to pass with no changes to that section and the requirements would then have to go through a more defined rule-making. We’re a long way from knowing whether or how the cost-splitting approach will be adopted.
Air ambulance balance billing also received some consideration in the Federal Aviation Agency (FAA) Reauthorization Act, signed into law in October 2018. The Act requires the Departments of Transportation (DOT) and Health and Human Services to set up a joint advisory committee whose goal it would be to suggest federal regulations on air ambulance patient billing.
As of early June, there has been no word on the committee’s progress or whether it has met at all.
What Payers Can Do Now
We’re seeing a number of legislative approaches to limiting egregious balance bills by air ambulances, but most are in their initial stages, and it may be years before we see any government actions.
In the meantime, payers can be proactive in reducing ambulance costs for their members and themselves through a pre-payment cost management strategy such as the one found at Zelis Healthcare.
Zelis’s comprehensive approach helps reduce ambulance costs by extracting waste and abuse in out-of-network claims. This solution is managed through an integrated strategy driven by claim selection technology, clinical algorithms, and an intense focused audit. The clinical audit includes medical necessity to confirm air transport was the most appropriate method of transport. Audit ensures air instead of ground transport required and confirms patient transferred to the closest facility to ensure proper level of care Moreover, experienced Zelis negotiators leverage provider data and negotiation history to ensure the most appropriate reimbursement.
Zelis utilizes a team of professionals who bring an unparalleled depth of insight and experience to the management of unsubstantiated and costly air ambulance claims. Partner with Zelis to help work through complex air ambulance claim reviews providing the appropriate reimbursement of care.