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Air Ambulance Advisory Panel Set to Address Astronomical Bills

Friday, September 13, 2019   (0 Comments)
Posted by: TCAA Staff
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Air Ambulance Advisory Panel Set to Address Astronomical Bills
  • Committee to advise Transportation Department on consumer protections and enforcement authority
  • Wyoming prepares to ask for federal OK to have Medicaid cover air ambulance bills
By Sara Hansard|September 12, 2019 05:49 PM ET|Bloomberg Law

A federal advisory committee that will review ways to protect consumers from sky-high bills for air ambulance services is one step closer to getting to work.

Thirteen members representing a range of health-care interests have been named to the Air Ambulance and Patient Billing Advisory Committee.Transportation Secretary Elaine Chao announced their appointment Sept. 12.


Among the members is North Dakota insurance commissioner Jon Godfread, whose state lost a court challenge from air ambulance companies over its efforts to rein in soaring rates. Other members include representatives of medical, health insurance, air ambulance, employer, and consumer groups.


Insurers, employers, consumer groups, and state insurance regulators have called on Congress to take steps to limit charges from air ambulance companies that sometimes run into the tens of thousands of dollars. The companies are exempt from state regulation under the Airline Deregulation Act.


The panel was created by the FAA Reauthorization Act of 2018. The air ambulance industry asked for it, saying the federal government should study its costs to operate, which it says are higher than Medicare reimbursements.


The committee will advise the transportation secretary about air ambulance services and patient billing, according to the DOT announcement. It will make recommendations regarding disclosure of fees for air ambulance services and insurance coverage, as well as consumer protection and enforcement authority of the DOT and state authorities, and on preventing balance billing to consumers.


States Ask for Help

The appointment of the committee’s members comes as frustrated state officials are urging members of Congress to take action.


Legislation approved by the Senate Health, Education, Labor and Pensions Committee (S. 1895) includes a provision that would allow insurers to pay for air ambulance services at rates based on median in-network rates. The air ambulance industry argues it “would devastate the provision of this service in the United States.”


State insurance regulators support the Senate HELP Committee provision. “Currently, states have very limited authority to regulate air ambulances,” 32 state insurance regulators said in a Sept. 4 letter to committee leaders.


“States have been unable to enact meaningful legislation to protect consumers because certain courts have interpreted that the federal Aviation Deregulation Act of 1978 (ADA) preempts state regulations on air ambulance providers,” the state insurance regulators said.


“This interpretation of the ADA protects air carriers’ prices, routes, and services from state regulation. That’s why a federal solution is needed,” they said.


‘Raised the Attention Level’

One state plans to seek the Trump administration’s OK on a novel approach to the problem.

The Wyoming Department of Health plans to ask the federal Department of Health and Human Services for approval to to make all state citizens eligible for coverage of air ambulance services under Medicaid, Denise Burke, senior policy and planning analyst with that state’s Department of Insurance, said in an interview.


Public comment period on the planned application ends Sept. 30, and Burke said state officials plan to file the request “immediately thereafter.”


The state’s plan to deal with air ambulance charges has “raised the attention level,” Burke said.

“We’re getting calls from other states saying ‘keep us posted.’ If they say no, we’ll at least get reasons why,” she said, referring to the HHS. “That will give us an opportunity to try another approach.”


The state’s Department of Insurance has received complaints of bills between $30,000 and $70,000 for air ambulance services in 2019, Burke said. Wyoming employers pay an average of $36,000 per flight, according to the state Department of Health.


‘A Delay Tactic’

The committee was supposed to have been appointed within 180 days of the enactment of the FAA reauthorization bill, a deadline that has long passed, and a report was to be made to Congress 180 days after that. President Donald Trump signed the reauthorization bill into law Oct. 5, 2018.


North Dakota insurance commissioner Godfread said in an email he thinks the advisory panel is a “delay tactic being used by the Air Ambulance Industry.”


“They are attempting to say, ‘See we are working on it, let the process play out,’ but this committee should have been formed over a year ago and the work should already be done,” Godfread said. “A law change from Congress that prevents this predatory activity by the bad actors in this space is the only way to get true consumer protection.”


Rick Sherlock, chief executive officer of the Association of Air Medical Services, said in an email, “AAMS welcomes the formation of this Advisory Committee, which is a crucial step for protecting patients from surprise bills that insurers refuse to pay.”


To contact the reporter on this story: Sara Hansard in Washington at

To contact the editors responsible for this story: Fawn Johnson at fjohnson@bloomberglaw.comBrent Bierman at bbierman@bloomberglaw.

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