Protecting Patients from Air Ambulance Surprise Balance Bills – Where Are We Now?

By: Maanasa Kona and Sabrina Corlette

A recently released report by the Health Care Cost Institute finds that the average price of an air ambulance trip has increased significantly from 2008 to 2017—144% for helicopters and 166% for planes. As of 2018, the average price of an air ambulance trip was around $28,000 for helicopters and $41,000 for planes. At the same time, a U.S. Government Accountability Office (GAO) report from earlier this year found that 69% of air ambulance rides in 2017 were out-of-network, meaning that insurers often don’t pick up the tab, placing patients at significant financial risk.

As we have written before, states like North Dakota and Wyoming have attempted to protect consumers from balance billing by air ambulance providers, but state policymakers’ hands remain tied because the Federal Aviation Act (FAA) preempts states from regulating the price of air transportation. State insurance commissioners and consumer advocates have urged Congress to take action and either address the issue at a federal level or to loosen up the FAA’s preemption to allow states to at least regulate the billing practices of air ambulance providers.

In response, Congress passed the FAA Reauthorization Act of 2018 requiring the Secretary of the U.S. Department of Transportation (DOT) to establish an Air Ambulance and Patient Billing Advisory Committee. The advisory committee is charged with reviewing options and issuing recommendations that improve disclosure of charges and fees for air ambulance services, better inform consumers, and prevent balance billing. On September 13, 2019, DOT announced the formation of the committee and its 13 members. The committee is scheduled to convene early next year but progress has been slow and, as mentioned, the committee’s power is limited to offering recommendations.

This year, Congress has yet another opportunity to more directly and definitively fix the issue of air ambulance surprise bills. While a number of bills were introduced this year to tackle the issue of surprise billing in general, one bill in particular, the Senate HELP committee bill (S. 1895), goes further than the rest and prohibits air ambulance providers from balance billing enrollees. This bill has support from both sides of the political aisle as well as the National Association of Insurance Commissioners. On December 8, 2019, the House Energy and Commerce and the Senate HELP committees reached a deal on federal legislation to curb balance billing that extends patient protections to air ambulance. However, air ambulance providers have strongly objected to this language, and investment analysts have predicted that limits on their ability to balance bill patients could pose a significant credit risk for air ambulance companies. With so much at stake, it remains to be seen whether this issue will continue to be included as Congress enacts broader balance billing legislation.

It’s a lot to keep up with, but you can find out the latest on air ambulances and balance billing by visiting our resource center here.

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The opinions expressed here are solely those of the individual blog post authors and do not represent the views of Georgetown University, the Center on Health Insurance Reforms, any organization that the author is affiliated with, or the opinions of any other author who publishes on this blog.