As Congress debates a remedy to surprise medical billing, it must not forget the importance of preserving patient access to emergency lifesaving care, particularly in America’s rural communities where hospital closures are hitting crisis levels.
Patients today are increasingly located farther away from care, and nowhere is that truer than Alaska, where 82% of communities aren’t connected by road. In emergency situations, many Alaskans in these communities rely on air ambulances to quickly care for and transport them to the most appropriate health care facility as ordered by an attending physician or EMT.
However, despite the importance of this service to Alaska patients, the ongoing availability of emergency air medical services to Alaskans is currently at risk because of misguided legislative proposals.
Emergency air medical services have been scrutinized because of anecdotal stories about large balance bills received by patients. Unfortunately, most of these stories fail to point out the root cause of the issue: denials by private insurers and chronic under-reimbursement by government payers.
Seventy percent of patients transported by air medical are covered by Medicare, Medicaid, another form of government insurance or have no insurance at all. With Medicare reimbursement rates last updated 20 years ago, the majority of all air medical transports are reimbursed far below the true cost of care. In order to continue providing lifesaving services, especially to rural areas, operating costs are shifted onto private insurers. While these companies are able to cover this lifesaving service for their customers, with reports showing it would cost patients as little as $1.70 per month in additional premium, many insurers refuse to go in-network with air medical providers or arbitrarily deny coverage, both of which leave patients with surprise bills.
Comprehensive data collection from air medical providers and insurers remains the best way to solve this issue. Doing so will allow policymakers to have a deeper understanding of the root causes of balance billing, as well as the rate at which they actually happen. When data has been collected, it’s been found to dispel many misperceptions. A recent YouGov survey revealed that most Americans thought that around 70% of air medical patients ended up with a balance bill. However, a study by the Wyoming Department of Health revealed that number is less than 10%.
While data collection remains the most important next step toward a feasible solution to solving billing issues for air medical patients, congressional efforts don’t quite meet the mark. The Senate Committee on Health, Education, Labor, and Pensions’ Lower Health Care Costs Act not only doesn’t call for data collection, it also would likely reduce patient access to air medical services. Section 105 of the legislation would allow insurers to pay providers the “median in-network rate” for their services, which could be even lower than the rates they currently receive. This would jeopardize patient access to care even further and make it harder for Alaskans to access emergency care.
The proposal also fails to address the predatory practices of insurers, such as coverage denials, despite the fact that Americans have made it clear this is one of the steps they would like to see taken. YouGov’s survey revealed that 87% of patients believe health insurance companies should not deny coverage for a service ordered by a medical professional. That number climbs to 93% of patients in rural areas. A majority of respondents also noted that they would be less likely to vote for a representative or senator who backed legislation that favored insurance providers.
Patients have made the choice very clear. We urge Sen. Lisa Murkowski, who sits on the Health, Education, Labor and Pensions Committee, to reject the Lower Health Care Costs Act in favor of a better solution to surprise bills. Patients don’t want to see their access to emergency health care become increasingly limited, and they want to see their elected officials hold insurers accountable for bad-faith practices. This proposed legislation doesn’t measure up on either account. Instead, Sen. Murkowski should support a data-driven, more comprehensive solution to surprise bills. Otherwise, thousands of Alaskans in need won’t have to worry about receiving surprise bills since they won’t have access to care in the first place.
Carter Johnson is spokeswoman for the Save Our Air Medical Resources campaign.