Health insurers’ national association AHIP has come out in strong support of HHS’ plan to implement a No Surprises Act regulation to put a cap on the patient cost for out-of-network air ambulance services. In a brief filed in the DC District Court in the Association of Air Medical Services vs the HHS lawsuit, AHIP argued that no one should face a surprise medical bill that could lead to financial ruin, particularly those who require emergency transport by air ambulance.
- Separate law shields air ambulance providers: In the brief, AHIP’s amicus pointed out that air ambulance providers are protected from the state regulation by a separate broadly written federal law. This has allowed them to stay outside of health plan networks at a greater rate than any other form of emergency care. About 69-75% of air ambulance transports are out-of-network, compared to 51% of ground ambulance transports and 14-22% of emergency department services, it said.
- Leveraging out-of-network status: AHIP argued that air ambulance providers have leveraged out-of-network status to extract large payments from patients with commercial insurance. It cited how a presentation by the Association of Air Medical Service showed that 70% of air ambulance revenue comes from the roughly 30% of their transports that are covered by commercial insurance, with privately insured patients and their insurance providers paying more than double the cost of services.
- Networks central to No Surprises Act: When establishing the Qualifying Payment Amount methodology for air ambulances, the US departments sensibly grappled with unique market dynamics, the brief mentioned. It said networks are central to the No Surprises Act. “Having largely relied on a business model that focused on remaining out-of-network for so long, air ambulance providers can hardly fault the Departments for implementing the QPA in a manner that reasonably responds to the dearth of air ambulance network agreements.”
- Focus on increasing revenue: The amicus submitted that over time, air ambulance providers have shifted from a non-profit hospital-based model to a model where air ambulance services are provided by a handful of independent for-profit firms, focused on ‘increasing revenue.’ The brief said private equity firms, in particular, have invested heavily in air ambulance providers and leveraged their larger market share, and the absence of meaningful regulation, to aggressively raise prices.
- The AAMS lawsuit: Challenging the interim final regulations (IFRs) implementing the No Surprises Act in a lawsuit filed last November, AAMS argued that a fair process in which all factors – including the type of aircraft, the quality of the services provided, and the acuity of the patient, among others – are considered when deciding a payment dispute can ensure the sustainability of air medical services and the larger healthcare system.