Two out of every five transports by helicopter ambulance result in a potential out-of-network bill of almost $20,000 on average, according to research published in the Millbank Quarterly.
Expensive air transport has been one of the signature issues in the debate about surprise out-of-network bills because it usually occurs in an emergency with little, if any, opportunity for the patient to select an in-network provider.
Using a database that includes claims from Aetna, Humana and UnitedHealthcare, a research team lead by Erin C. Fuse Brown of Georgia State University found that 77% (24,965 of 32,215) of helicopter transports were out-of-network during the 2014-2017 period they studied
That proportion is considerably higher than what the Government Accountability Office (69%) and others have found, perhaps partly because of how Fuse Brown and her colleagues classified claims (if the network status wasn’t explicitly identified, they classified it as out of network)
Their research found that Insurers paid out-of-network air ambulances charges in full 48% of the time, thereby eliminating the chance of a surprise balance bill bill. When the air ambulance paid in full, those out-of-network charges averaged $35,753, according to Fuse Brown and her colleagues.
The other 52% of the time the out-of-network claim was not paid in full, and patients were potentially liable for a balance bill for 40% of helicopter transports, with an average potential bill of $19,851, according to the the researchers' calculations.
In a discussion of legal issues, Fuse Brown, a law professor at Georgia State University, and her colleagues say that the federal 1978 Airline Deregulation Act effectively prevents states from regulating air ambulance insurance and rates, so federal legislation would be needed to curb out-of-network bills. The 2018 FAA Reauthorization Act might have tackled out-of-network billing, but an advisory committee has focused on price transparency. The researchers note, though, that states have come up with “creative” ways to curb air ambulance billing. They mention Wyoming, which has proposed to pay for all air ambulance services through Medicaid, including people with private insurance.