The Unfinished Business Of Air Ambulance Bills
Erin C. Fuse Brown, Loren Adler, Karan R. Chhabra, Barak D. Richman, Erin Trish, 26 March 2021
On December 27, 2020, tucked into the year-end coronavirus relief package and spending bill, Congress passed the No Surprises Act, largely ending the practice of surprise out-of-network medical bills. In a win for patients, the law applies to air ambulance operators as well as out-of-network providers and facilities that provide emergency and non-emergency health services. Nevertheless, the law’s consumer protections don’t go far enough to protect patients from the financial risks of an air ambulance transport.
Effective January 1, 2022, the No Surprises Act generally prohibits out-of-network providers in emergencies and at in-network facilities from billing patients for more than their in-network cost-sharing amounts (eliminating patient balance-billing) and sets up a dispute resolution process to determine the amount the patient’s health plan will pay for the out-of-network care.
If the out-of-network provider and the payer cannot agree on a rate through negotiation, the parties can pursue “baseball-style” arbitration and submit their final proposed rates to the arbitrator, who must then select one of the proposed rates. The arbitrator is directed to consider certain factors to select the winning rate, including the median in-network rates for the services in the area, the acuity of the case, and prior contracted rates or attempts to contract between the parties. In addition to these factors, the arbitrator can consider the air ambulance vehicle type (for example, fixed or rotary wing), the vehicle’s clinical capacity, and the population density of the pick-up site. Either party can present any other information they wish, with the important exception that the arbitrator is prohibited from considering both the provider’s billed or usual and customary charges and public payer rates, such as those paid by Medicare, Medicaid, or the Children’s Health Insurance Program.
