The Hill: Kathryn Green of Greenwood, Mississippi, called 911 after her husband fell and suffered a head injury at home. The EMTs called an air ambulance to fly Kathryn’s husband from their home to the hospital. However, the air ambulance company they called was not in Kathryn’s insurance network, and after her insurance covered a fraction of the $58,142 charge, she received a bill for $50,950 from a company called Rocky Mountain Holdings. Tragically, Kathryn’s husband passed away after a week in the hospital. At the same time she was grieving the death of her husband, Rocky Mountain Holdings, a subsidiary of Air Methods, began relentlessly pursuing collection of the air ambulance transport bill.
Whether in remote rural areas or sprawling suburbs, there are critical occasions when patients need to be airlifted to medical care in an emergency. In these urgent situations — like the Green’s — where every minute matters, patients aren’t in the position to evaluate whether air transport is a medical necessity, nor to research and decide which air ambulance provider is going to pick them up. That can end up leading to surprise expenses when the air ambulance company bills the patient for the full charges or the balance left after insurance coverage, if any, is applied.
And these bills can be astronomical – ranging from $15,000 to $100,000 and up. At Consumers Union, the policy and mobilization arm of Consumer Reports, we have received stories from consumers across the country hit with these crippling surprise air ambulance bills. State insurance commissioners, too, have heard from constituents faced with these bills.
To protect patients from this kind of financial devastation, Congress must amend the Airline Deregulation Act of 1978 and make it clear that states are authorized to oversee and regulate air ambulance services. Despite industry claims (Allen of Air Methods and Myers of Air Evac Lifestream in this publication alone) that air ambulance services are “meticulously regulated,” the Airline Deregulation Act broadly preempts states from regulating the “price, route, or service of an air carrier,” including air ambulances. States have repeatedly enacted consumer protection statutes and promulgated regulations on air ambulances, only to be thwarted by industry arguments of federal preemption. Some air ambulance providers have relied on this federal law to preserve their practices of billing patients for the balance left after any insurance payment, and have left a long history of aggressive debt collection practices.
There are also concerns that these emergency transportation services are being utilized to help boost profits, even when the transport is not medically necessary. The number of emergency helicopters operating has dramatically increased since 2002, coinciding with an increase in Medicare reimbursement rates for these services. Between 2003 and 2015, the number of medical helicopters nearly doubled, from 545 helicopters flying out of 472 air bases to 1,045 helicopters at 864 bases.
Moreover, where the market used to be predominantly government and hospital-affiliated helicopters, the independent, for-profit sector has grown enormously since 2003, now owning one-half of the market share. As a July 2017 GAO report noted, large independent providers have higher prices and are far less likely to contract with insurers. They are thus considerably more likely to be out-of-network with health plans, resulting in more high-balance billing of consumers.
While competition theoretically keeps prices in check, it appears to have had the opposite effect in the air ambulance market, as both the number of air transports per year and their prices have risen significantly.
The upcoming reauthorization of the FAA provides a key opportunity for bipartisan efforts in Congress to address these system problems. Rep. Rob Woodall ‘s (R-Ga.) amendment, added to the bill in Committee markup, provides for a DOT rulemaking, based on input from an advisory committee with consumer representation, to collect data from the industry to pin down exactly how much of the air ambulance charges are transportation-related and how much are for other medical services, establish a toll-free hotline for consumer complaints, zero in on unfair and deceptive practices, and provide other consumer protections as determined to be warranted.
We believe this is an important first step, and encourage Senate leaders to incorporate this amendment in their FAA Reauthorization proposal. However, we would suggest they go further and clarify that states are not preempted from applying health insurance laws governing network participation, reimbursement, price transparency, and balance billing to air ambulance service, to better enable consumers to obtain coverage under their insurance. Sen. Jon Tester (D-Mont.) has also introduced legislation, the Isla Rose Life Flight Act, which would address these issues by allowing state governments to regulate air ambulance billing and pricing practices to ensure policies are transparent for patients. We strongly support this robust, pro-consumer legislation, and urge Senators to move forward on this bill.
There is no doubt that air ambulances can provide critical, life-saving services, especially in rural communities where patients may not have local access to emergency facilities. Industry voices are quick to highlight the important role the industry plays — and we don’t disagree. What these arguments fail to address, however, are industry practices that cost consumers dearly.
Patients who survive a medical emergency should not then be forced into bankruptcy and lose their homes from over-the-top air ambulance bills. We urge Congress to take action this year to protect consumers by adopting the Woodall amendment to the FAA Reauthorization bills, moving on the Isla Rose Life Flight Act, and examining other ways to address consumer concerns in the air ambulance industry.
Betsy Imholz is Special Projects Director for Consumers Union, the policy and mobilization arm of Consumer Reports.