Pennsylvania Fights Against Large, Surprise Bills For Air Ambulance Services

Apr 24, 2017

Insurance Commissioner Teresa Miller wants more control over how patients are billed for air ambulance services and is calling on the U.S. Senate to take action.

Miller has been working since taking office to reduce something called “balance” or “surprise” billing -- it happens when a patient gets an unexpected bill for a service not covered by their insurance. Though, she said she hasn’t been able to make any progress when it comes to bills for air ambulance services because it is unique.

“First, because you are dealing with really large bills, but also it’s unique because of … The Airline Deregulation Act of 1978,” Miller said. “That act preempts state regulation of air services including air ambulance services.”

That means states cannot enact laws regulating how much services such as LifeFlight and Stat Medevac charge.

Miller said the cost of an air ambulance trip can reach $50,000, but some insurance companies will only cover one-quarter of that, leaving the patient to pay the rest.

“I think the way we would go about trying to address it is the same way we addressed the balance billing issue generally,” Miller said, “which is to bring all the stakeholders together, sit down and say, ‘What are we solving for?’ and then ‘What can we do to get consumers out of the middle of this so they’re not getting these really, really high balance bills?’”

A law in South Dakota regulating charges was struck down by a federal court last year. The problem has gained national attention and the U.S. Senate is considering legislation to change the 1987 law.

Miller has written a letter to Pennsylvania senators asking for their support on the measure. She said there needs to be a carve-out of the air ambulance services when it comes to billing.

LifeFlight and Stat Medevac serve most of the air ambulance needs in the Pittsburgh region. Both are affiliated with a hospital and insurance system, which Miller said can help. Neither company commented for this story.

A study released by the New Mexico Office Superintendent of Insurance found the actual cost of the average air ambulance helicopter flight is about $10,000, but the bills are usually four to five times that. The industry has responded by saying it needs to issue the higher bills to private insurance and self-pay patients due to the low rate of reimbursement by Medicare and Medicaid.

Miller said, while the law is not on her side, she recommends that people in Pennsylvania hit with a big bill for an air ambulance should file a complaint with her office.

“We will push hard to try to protect that and to eliminate that balance bill for them, and in some cases we have been successful,” she said.

Miller said the goal is to “take the consumer out of the middle of the debate” and find a way to reach a “reasonable and appropriate” rate for the service.