Air ambulance billing, collections draw concern from state regulator

Air ambulance companies in Missouri use the practice of balance billing to stick patients with bills for tens of thousands of dollars, according to a new report from the Missouri Department of Insurance, Financial Institutions and Professional Registration, or DIFP.

Balance billing is the practice of charging a patient the difference between what a health care provider bills and an insurance company pays. Providers that participate in Medicare and Medicaid programs are restricted from using balance billing for amounts that exceed negotiated reimbursement rates. The same is true for providers that participate in most private insurers’ networks.

However, many air ambulance companies in Missouri don’t participate in insurer networks, meaning they are not bound by the same negotiated reimbursement rates as providers that do. That’s a problem, the report says, because patients often have little say in which air ambulance provider is called. In some cases, patients with private insurance were billed more than $100,000 for air transportation.

But it’s not just patients who use air ambulances that end up paying, according to the DIFP. Private health insurance bears the brunt of costs for air transportation, which leads to higher health insurance premiums for everyone.

The DIFP estimates that air ambulance providers charged a total of $25.7 million for their services in Missouri in 2017. Of that amount, patients could have been balance-billed up to $12.4 million, the DIFP estimates, which comes out to $20,000 billed to each individual.

The report also cites “vigorous collection efforts,” including wage garnishments and liens, by some air ambulance companies. The four most legally active companies have combined for 427 collection actions since 2012, according to the DIFP.

“With air ambulance bills, Missourians are subjected to extremely aggressive collection efforts, at a time when they are quite vulnerable as they are already recovering from a medical emergency,” Chlora Lindley-Myers, the department’s director, said in a release. “We hope this report illustrates to state and federal policymakers the scope and seriousness of this problem and the need for urgent action.”

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