Air ambulance prices double, GAO says. Should Florida do anything?

Helicopter air ambulance prices approximately doubled in four years, a new government report finds as Florida officials consider possible legislation by next spring to limit what consumers pay for emergency transportation.

The median price rose from around $15,000 to about $30,000 per air trip between 2010 and 2014, according to Medicare data from the Centers for Medicare & Medicaid Services and private health insurance data, a U.S. Government Accountability Office report found.

Paul Webster, vice president of air ambulance provider Air Methods Corp., talks to a state panel in June.

“Air ambulance providers might bill a privately-insured patient for the difference between the price charged and the insurance payment— a practice called balance billing— when the provider lacks an in-network contract with the insurer,” the GAO report said.

Balance billing is the amount consumers can be charged, sometimes to their shock, after insurers or agencies have paid what they see as appropriate. It’s a key issue for a state working group led by Florida Insurance Consumer Advocate Sha’Ron James. State officials have heard examples of consumers charged up to $1,000 or more for ground ambulances, and up to $42,000 for air transport.

While grateful for life-saving services, many consumers question why they should be billed an open-ended amount for an ambulance ride that could strain family budgets or push some toward bankruptcy. Many already pay taxes for municipal services in addition to insurance premiums. They don’t realize most ambulance services, private or public, decline to join insurer networks.

“We believe in a balance-billing prohibition,” said Wences Troncoso, vice president and general counsel of the Florida Association of Health Plans, at a meeting in June. He called for rules that essentially would mean an air ambulance provider has to work out payment with the insurer, not the consumer.

For their part, air ambulance providers have questioned whether federal law lets states regulate prices for air travel, plus they say insurers often want to pay too little to keep them in the air.

“We would love to go in network” with insurers, said Paul Webster, vice president of Colorado-based Air  Methods Corp., a private operator of air ambulance services. “Unfortunately in many states we are met with rates we can’t live with and access would be limited.”

 

Air ambulances: Insurers call for end to balance billing to consumers

Consumers should not receive devastating bills for tens of thousands of dollars for air ambulance transport when providers and insurers cannot agree on a reimbursement, a group representing Florida insurers told a state panel Tuesday.

Paul Webster, vice president of air ambulance provider Air Methods Corp., talks to a state panel Tuesday.

That is often called “balance billing,” and participants cited cases of consumer charges ranging up to $42,000 or more.

“We believe in a balance-billing prohibition,” said Wences Troncoso, vice president and general counsel of the Florida Association of Health Plans. He called for rules that would mean an air ambulance provider essentially has to work out payment with the insurer, not the consumer, he said.

But air ambulance providers questioned whether federal law covering air travel even allows states in effect to regulate prices and services, and they said in any case insurers often propose to pay far less than they need to stay in the air.

“We would love to go in network” with insurers, said Paul Webster, vice president of Colorado-based Air  Methods Corp., a private operator of air ambulance services. “Unfortunately in many states we are met with rates we can’t live with and access would be limited.”

Florida Insurance Consumer Advocate Sha’Ron James, who hosted a working group meeting for the third time Tuesday, said bills often leave individual families “shocked.” At the same time, consumers are typically grateful for life-saving services and air transport remains a “distinct and complex” issue, she said.

The state’s  emergency medical transportation working group is looking at possible solutions ahead of next year’s legislative session. An earlier session examined ground ambulances. After heavy debate, ambulances were left out of a law Florida passed last year that limited consumer charges from out-of-network medical providers in situations where the patient has no reasonable choice to shop around.

 

Palm Beach ambulance official: We are ‘framed’ on balance billing

Consumers from Palm Beach County and around the state are telling Florida officials they fear calling 911 because of ambulance charges that come as a shock, but ambulance officials said at a meeting Tuesday they are being set up for blame on so-called balance billing.

“The ambulance providers are being framed as the cause of this balance billing when it’s actually the insurance provider,” said Darrel Donatto, Deputy Fire Rescue Chief for the town of Palm Beach.

Bonny and Ed Fishman say they were surprised by an ambulance charge of more than $800. (Damon Higgins / The Palm Beach Post)
Bonny and Ed Fishman say they were surprised by an ambulance charge of more than $800. (Damon Higgins / The Palm Beach Post)

Consumers may get hit with bills they are not expecting because their insurers are not covering the full amounts charged, said Donatto, who is active with state and local fire chief associations.  Any potential moves by state legislators to limit what ambulance services can bill consumers will likely shift costs to taxpayers, he said.

“The question is, should taxpayers be subsidizing the insurers with record profits?” Donatto said.

Insurance industry officials responded they are among the nation’s most regulated industries, effectively limiting profits they can keep.

“We don’t want our consumers to be receiving balance bills,” said Wences Troncoso, vice president and general counsel for the Florida Association of Health Plans.

“I think we’re both trying to achieve the same thing at the end of the day and that’s protect the Florida consumer and achieve a fair outcome,” Troncoso said.

He  asked why most ambulance services choose not to join insurer networks and come up with a mutually-agreed contracted rate.

But Donatto said in his experience, there has been “no negotiation, no willingness” by insurers to pay sufficient reimbursement, making it “fiscally irresponsible” for ambulance providers to join.

With insurers and ambulance providers often locked in a stalemate, consumers feel caught in the middle, paying amounts they were not expecting.

A state working group led by Florida Insurance Consumer Advocate Sha’Ron James is exploring possible solutions to the deadlock for legislators to consider. A meeting Tuesday in Tallahassee focused on ground ambulance charges.

Complaints to state agencies show consumers are often upset that they pay taxes for ambulance services as well as insurance premiums, only to get billed after a ride for amounts that can range from several hundred dollars to more than $1,000.

Balance bills for air ambulance rides can be far higher, $25,000 or $35,000 or more. A later meeting of the working group, proposed for June 13, will address those. Any recommendations concerning possible actions by state legislators are expected to affect the 2018 session, not this spring’s gathering.

The Palm Beach Post reported Sunday on bills such as the one for more than $800 that caught Edward and Bonny Fishman of Boynton Beach by surprise.

Boca Raton Fire Rescue Services threatened to turn the Fishmans over to a collection agency if they did not pay, the couple said.

“I was shocked,” Edward Fishman, 64, said. “What is this? We pay taxes for fire and rescue. Why is there a charge? How do they determine how much they charge?”

Consumers say such charges can force them to consider the financial consequences of calling 911 rather than just focusing on getting medical help.

Bonny Fishman, 62, said, “If God forbid we were in an emergency in the future, I would think twice about calling an ambulance.”