By Sabrina Corlette and Maanasa Kona

Recent polls show that health care costs are among voters’ top concerns this election cycle, and surprise medical bills are the number one health care cost they’re worried about. One of the most egregious sources of surprise medical bills are air ambulance companies, many of which have been purchased by private equity firms whose primary mission is profit, not health care. Multiple media reports have documented that these outfits often charge patients, many of whom are critically injured and have no say in their mode of emergency transport, five or six or even ten times the average cost of a flight.

Several states have attempted to protect consumers from excessive billing in the air ambulance industry but face a significant barrier: the federal Airline Deregulation Act, which prevents them from enacting any law or regulation related to the “price, route, or service” of an air carrier. As a result, this year a coalition of state officials and consumer advocates prodded Congress to step in and help.

Congressional action in air ambulance billing: a day late and a dollar short

Some in Congress responded. Senator John Tester of Montana introduced S. 471, which would give states the authority to regulate air ambulance “network participation, reimbursement, and balance billing.” The U.S. House included a provision in the Federal Aviation Administration (FAA) Reauthorization Act that would require the U.S. Department of Transportation (DOT) to mandate that air ambulance providers clearly disclose charges for transportation and non-transportation services and “provide other consumer protections for customers of air ambulance operators.” While this provision would not have given states the clear authority to step in and stop egregious balance billing, it would have required a clear separation of medical and transport charges, with the potential that states could regulate the medical portion of the bill. The provision was passed by the House almost unanimously. However, it was not included in the Senate version of the FAA reauthorization.

Unfortunately, in the face of opposition from the air ambulance industry, Congress blinked, and the bill emerging from the House-Senate conference committee does nothing to protect consumers from surprise bills, does not mandate improved disclosures, and fails to give states the authority they need to step in.

Instead the bill does what Congress always does when it doesn’t want to upset industry – it calls for more data. Specifically, it would create an advisory committee to DOT to study air ambulance issues and encourage more data reporting to the agency. It further:

• Requires DOT to improve the transparency of its response to consumer complaints, “provide other consumer protections,” (unspecified), and issue a report to Congress describing its oversight efforts;
• Gives DOT the authority to investigate unfair and deceptive trade practices by air ambulance providers; and
• Requires that air ambulance bills include the phone number for a consumer complaint hotline.

Looking ahead

In the short-term, more consumers will face shockingly high bills from air ambulance providers, such as the $56,603 ride chronicled in this recent NPR story. If their insurer won’t pay, consumers have little recourse because federal law bars state regulators from stepping in. In the long term, it’s possible the DOT advisory committee and continued pressure from state regulators and advocates will lead to greater consumer protections. But don’t hold your breath for too long – you might need emergency medical transport.