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Maryland Insurance Administration investigating $20,000-$40,000 air ambulance bills

Maryland Insurance Administration investigating $20,000-$40,000 air ambulance bills

The Maryland Insurance Administration is investigating a string of consumer complaints about air ambulance bills in excess of $20,000 that the state insurance commissioner described as exorbitant.

These complaints represent a fraction of the roughly 3,700 trips air ambulances make a year. But the size of the bills a few patients have received — between $20,000 and $40,000 — has caught the attention of Maryland Insurance Commissioner Al Redmer Jr. He has called a Sept. 18 public meeting with hospitals, insurers and other stakeholders to discuss the issue and possible ways to resolve it.

“We will get involved based on the severity or based on the frequency,” Redmer said. “With this specific issue the severity is enough that the frequency is almost irrelevant.”

When a hospital does not have the resources or specialists to treat a critically ill patient, doctors will call for an air ambulance to quickly transport the patient to a larger hospital. While state police helicopters respond to accident scenes to transport victims to trauma centers, these hospital-to-hospital trips are typically handled by commercial air ambulance companies that bill insurance companies and patients for their services.

The complaints are from patients whose insurance plan paid only part of the bill and who are being asked by the air ambulance company to pick up the remainder of the tab. The meeting takes place at 10 a.m. Sept. 18 at the insurance administration’s Baltimore offices, 200 Saint Paul Place.

Here’s the problem: For most health care services, providers and insurance companies negotiate set rates for services. But federal aviation laws prohibit states from regulating rates and routes for aircraft, including the helicopters and small planes that transport patients in a medical emergency. Since air ambulance companies cannot be compelled to contract with insurers, some don’t and instead charge the rates they want.

Unlike most other emergency providers, air ambulance companies are allowed to bill patients for the remainder of a bill their insurer didn’t pay because the same federal regulations exempt air ambulance companies from insurance rules other health care providers must follow.

The practice, called balance billing, is especially troubling in this case because the patients who are transported by these air ambulances have no idea that the service is not covered by insurance or that it will cost so much. Doctors do not have time to check whether a patient’s insurance plan covers air transport when they are making split-second, life-or-death decisions. These patients are in such critical condition, most wouldn’t be able to consent, anyway.

Redmer is hopeful that bringing together local lawmakers, insurers and hospitals will be a first step toward filling the gaps. But the road ahead may be tough.

Attempts by other states to force insurers and air ambulance companies to play nice have met resistance.

North Dakota this year approved legislation that would create a priority call list for air ambulance services. Only companies that contract with insurers could make the list, effectively forcing them to negotiate. Valley Med Flight, a leading air ambulance provider in the state, is suing North Dakota’s Department of Health and Workforce Safety Insurance on the grounds that the law goes against federal airline deregulation laws.

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