We've heard from several people whose stories virtually mirrored that of Michael Seibert who was charged nearly $43,000 for an air medical transport to University Hospitals which no doubt saved his life. Overwhelmingly the company involved in the communications with us, is Air Methods and its subsidiary, Rocky Mountain Holdings.
U.S. Sen. Sherrod Brown (D-OH) today outlined new legislation to address the practice of “surprise billing,” when patients are faced with costly medical bills after unintentionally receiving care from an out-of-network provider.
WKYC Senior Health Correspondent Monica Robins asked Brown if the measure would include air ambulance transports.
"The patient is held harmless if there's a relationship with the hospital typically so I think the answer is probably yes and if there's a way of writing the bill slightly differently to include that we would look at doing that too," Brown said.
The End Surprise Billing Act would protect patients experiencing a medical emergency from being charged more than in-network rates for emergency care and provide patients scheduling services with more information about potential out-of-pocket costs.
More than 100 million Americans with health insurance have no legal protections against unexpected bills from out-of-network providers. According to recent surveys, up to 40 percent of insured Americans experience surprise medical bills in which a patient’s insurance company covers less of the cost than expected.
The End Surprise Billing Act (S. 284) would work to prevent millions of Americans from receiving surprise medical bills by protecting individuals experiencing a medical emergency from unexpected bills, and requiring all hospitals that participate in the Medicare program to have increased billing transparency with patients regarding potential out-of-network providers.
The End Surprise Billing Act would:
- Require hospitals to provide two written notices to insured individuals, clarifying whether the hospital or physician is an in-network provider, and estimating any potential out-of-network fees for the scheduled service;
- Require hospitals to obtain signed, informed consent from the individual seeking services from an out-of-network hospital or provider at least 24 hours in advance of the service;
- Simplify the billing process by prohibiting providers that fail to provide the above notices or obtain signed, informed consent from charging more than what that individual would have paid had the provider been in-network; and
- Protect individuals experiencing a medical emergency from surprise billing by prohibiting providers from charging more than the in-network cost of a service.
Meanwhile lawyers for Elk and Elk filed a Federal Class Action lawsuit against Air Methods and Rocky Mountain Holdings. Ohio is now one of four states involved in litigation against the company and attorney Jay Kelley expects two more states to be added to the list by the end of the week.
The lawsuit addresses exorbitant billing and aggressive collection tactics. Read the lawsuit below. Mobile users click here to view.
Federal Class Action lawsuit filed against Air Methods and Rocky Mountain Holdings by WKYC.com on Scribd
"It's patently obvious to us that what they're doing isn't fair, the person who's lying on the side of the road or in another hospital, they don't have a say in this decision, they deserve to be treated reasonably," Kelley said.
Michael Seibert and dozens of others we've heard from were transported by Air Methods to University Hospitals for medical care. UH contracts with Air Methods to provide this transport service, however the patient is billed separately for the service.
For many patients, the service is considered out of network, even if UH is the patient's in-network facility. It just depends on the agreement Air Methods has with individual insurance companies. Patients have received bills up to $50,000 for less than 20 minute helicopter rides.
"The rates that they've charged from 2007 to 2014 have more than tripled," Kelley says.
Many say more transparency in the industry is needed.
"They don't publish their prices or how they get to their price or the basis for their price other than a small component being price per mile," Kelley says.
Air Methods provided the following statement regarding the issue.
“Our mission is first and foremost to preserve emergency air medical service for all communities around the country to communities and people whose lives depend on it. We’re ready to deploy 24/7/365, and the crew only responds when called upon by a first responder or physician. And we truly believe that everyone deserves access to lifesaving care regardless of their ability to pay.
We’re an airborne ICU with a focus on quality of care and safety in aviation that exceed industry-wide standards. While we seek every efficiency and innovation to keep costs down – being ready to deploy our advanced fleet and highly trained clinicians and pilots at a moment’s notice requires substantial investment and high fixed costs. In fact, the average cost to operate one base is $3 million per year.
Our charges are comparable to average charges by other non-hospital affiliated air medical service providers. The fundamental problem is that current reimbursement rates by Medicare, Medicaid and some private insurance fall woefully short of what it actually costs for us to carry our air medical transports. Roughly 70% of our transports are patients who have either Medicare, Medicaid, some other government insurance coverage, or are uninsured; we are under-reimbursed on 7 out of 10 transports. At the same time, while most private insurers pay at or near our billed charges, there are some private insurers who are setting rates that are far below our true costs.
We balance bill only as a last resort, and even then, we work with patients one-on-one to recover what they deserve from their insurance company and to determine what they can reasonably pay. After the emergency is over, our team of patient advocates work with our patients to help them navigate the complex and often frustrating process of seeking fair reimbursement from insurance companies. In addition, we have a long-established charity care program in place to support patients who need further financial assistance.
We believe there are two important solutions that would reduce the financial burden on patients, while preserving access to air medical services across the country. First and foremost, we must fix the drastically low reimbursements from Medicare and Medicaid services. We strongly support the proposed federal legislation that would resolve the Medicare reimbursement shortfall by updating reimbursement rates.
Second, insurance companies must be willing to reimburse for emergency air medical services. Unfortunately, some highly-profitable insurance companies play a major role by placing the financial burden on patients through increasing insurance premiums and reductions of coverage.
As a responsible provider, we are working toward long-term and meaningful solutions and we continue to try to build collaborative partnerships with insurers who share our goal of putting the patient first and recognize the value of our lifesaving services.”
University Hospitals released this statement late Wednesday:
“We’re working with Air Methods and our insurers to resolve the billing issues and come to a positive resolution that best serves our patients now and in the future.”
One of the people who experienced the billing situation with Air Methods is an attorney who wanted to remain anonymous, but wanted consumers to have additional information to deal with their individual case.
- Do not sign any documents you receive including any titled "assignment of benefits", even if they are marked "required for insurance"
- Do not sign any appeals forms and make sure you represent yourself in any appeal process
- Do not sign any consent to release your health care information for their lobbying purposes
- Do work directly with your insurance carrier to submit your claim yourself or with the help of your HR dept.
- Do ask for a health advocate to be appointed for you by your employer or insurer who can assist you for free
- Do appeal if you don't get full coverage and ask for "in network" level of payment, even if they are considered "out of network"
- Do ask for reduced or waived "out of pocket maximums" from your insurer
- Do complain to your HR / insurance provider about too high of out of pocket maximums on your policy during insurance renewals
- Maximize your health care spending account elections each year
- File a complaint with The Ohio Attorney General