The last thing anyone thinks about during an emergency is the cost of getting a severely injured patient to a hospital that can provide life-saving care.
When it comes to services such as air ambulances, however, saving a life could cost the victim and their family tens of thousands of dollars.
The only level one trauma center in the state is at the University of Mississippi Medical Center in Jackson. For Vicksburg and Warren County—all Central Mississippi, in fact—the fastest way to get a patient to UMMC is by AirCare helicopter ambulance, a service that most health insurance plans cover, at least to some extent, when those services are in-network.
Of course, emergency patients are rarely able to ask whether an ambulance is in their insurance network or to demand that service be provided only by those that are in-network. Ambulance services, at the same time, don’t limit responses to patients whose insurance includes them.
For AirCare trips, it may be irrelevant in every case. In May, UMMC is changing its vendor for AirCare, reports WAPT, and the new vendor, Med-Trans, is out-of-network for every private health insurance provider in Mississippi.
“We’re currently working with our partners at UMMC to negotiate an agreement with (Blue Cross Blue Shield),” Med-Tran’s Robbie Copeland told the station.
About two-thirds of air ambulance trips in 2017 were out-of-network, a 2019 Government Accountability Office report revealed, much higher than ambulance trips in general. Bills to cover the difference between what insurance pays and the total bill, called balance billing—or more popularly “surprise” billing—can threaten patients’ bank accounts.
“Privately-insured patients transported by air ambulance providers outside of their insurers’ provider networks are at financial risk for balance bills—which … are for the difference between prices charged by providers and payments by insurers,” the report’s authors wrote. “Any balance bills are in addition to copayments or other types of cost-sharing typically paid by patients under their insurance coverage.”
An air ambulance trip averages about $36,400, the GAO report states. Of 60 complaints the authors reviewed, all but one complained about balance billing in excess of $10,000.
The high end of the balance billing complaints was $66,000. In one example from North Dakota, the air ambulance provider charged $41,400, and the patient’s insurer paid only $6,700, leaving a balance of approximately $34,700.
The Mississippi Department of Insurance says on its website that the average air ambulance trip is 52 miles, about the distance from Vicksburg to Jackson, and costs between $10,000 and $25,000.
“The emergency nature of most air ambulance transports, as well as their relative rarity and high prices charged, reduces the incentives of both air ambulance providers and insurers to enter into contracts with agreed upon payment rates, which means air ambulance providers may be more often out-of-network when compared with other types of providers,” the report states.
Copeland indicated that Med-Care will work with patients to help them if their insurance denies their claims.
“Generally, officials from air ambulance providers we spoke to said that they first encourage patients to appeal to their insurers for increased payment,” the GAO report states. “If these appeals do not fully address the balance bill, the providers may offer various payment options. For example, officials from one air ambulance provider said that it offers a discount of up to 50 percent off the balance bill if the patient pays the remaining 50 percent immediately.”
Even with discounts, however, a patient can still be on the hook for tens of thousands of dollars.
On the national level, Congress is making an attempt to rein in balance billing, which can affect all kinds of hospital services, not just ambulance services. Doctors, hospitals and insurers—including air ambulance services—pushed back to protect their bottom lines against bills proposed in 2019, effectively killing the legislation, and their political action groups are donating heavily to 2020 campaigns.
The latest draft bill from the House Ways and Means Committee released earlier this month does not propose to ban balance billing from air ambulance providers, only to require reporting of cost data.