Along with our own efforts to partner with insurance companies, we continue to work with state and federal legislatures for a more accurate Medicaid and Medicare reimbursement model. Currently, more than 70 percent of air medical flights are Medicare, Medicaid or self-pay/uninsured, which only covers approximately 30 percent of the median cost of a flight. At the federal level, we support legislation that would preserve access to these life-saving services, while addressing the issue of consumer costs by updating the Medicare reimbursement rates of air medical services to be based on the actual cost of care, which has not been updated in over 20 years.
I would also be remiss if I didn’t point out a few elements that are missing from the study. It does not look at the denial rate of health insurance companies when it comes to emergency air medical transports. On average, more than 50 percent of our emergency air medical transport claims are denied by insurance companies on first examination. That means the patient and the provider must appeal to the insurance company for payment using the process created by the insurance company itself. And it often takes months of appeals before the patient knows whether their insurance company will cover the cost of the emergency air medical transport. Almost every single denial is overturned after this lengthy and time-consuming appeal process.
At Air Methods, we only balance-bill for two very specific reasons: First, if the patient does not provide us with their insurance coverage information so we can bill their insurance company or if they do not assist in the appeals process – which is a requirement set by the insurance company; Second, if the insurance company sends the payment for emergency services directly to the patient, who then either willfully or as directed by insurance, does not send the reimbursement check to Air Methods (the provider) for payment of medical care.
The authors of the study point out that they “were not able to observe whether patients were balance-billed.” That means the dramatic phrasing of the Health Affairs headline is misleading—the potential for a balance bill does not equate to an actual balance bill. A health insurance company’s reimbursement behavior dictates that potential. The study lays the blame for a potential balance bill not at the feet of the insurance company for its lack of reimbursement, but solely with the provider.
Our healthcare system is complicated and, unfortunately, patients are indeed often caught in the middle. While the issue of balance billing and the cost of air medical transportation is complex, Air Methods continues to actively work with all willing parties to make sure patients can focus on recovery and that insurance fairly covers this necessary service.
About the author: JaeLynn Williams is the CEO of Air Methods.Back to HCB News
