Section 105 of the “Lower Health Care Costs Act” will do irreparable harm to the ability of emergency air medical services to provide life-saving care to critically-ill and injured patients. AAMS fully supports efforts to prevent insured patients from receiving balance bills when insurers refuse to pay for the emergency healthcare those patients receive.  

By setting the default payment rate for emergency air medical services to the “median-in-network rate”, the legislation would devastate the provision of this service in the United States.

  • No Data: There is no available data on “median in-network rates” for air ambulances. Some insurers refuse to even discuss in-network agreements with air ambulance providers. In the absence of data Section 105 could drive in-network rates to parity with Medicare rates which are already 40% below cost.
  • Cripples the Market: There would be no incentive for insurers to enter in-network agreements with air ambulance providers; existing agreements will crumble and the market will cease to function.
  • Race to the Bottom: With no recourse to address insurance underpayment, insurers will demand ever diminishing in-network payments in the same “take-it-or-leave-it” proposals that are being offered now.
  • Destroys Access to Healthcare for Millions of Americans:  Thirty-two air medical bases across the country have already closed in 2019. The “Lower Health Care Costs Act” will greatly accelerate this erosion of health care access, especially in rural areas.
  • Allows the Continued Questioning of Doctors: Only doctors and first-responders are allowed to request emergency air medical services; insurers are currently allowed to question those decisions and often- more than 40% of the time- deny payment to the provider because of these questions. Nearly all of those denials are overturned on appeal, however insurers continue this practice in an effort to limit resources.

At a time when rural hospitals are closing, it is critical to maintain, or even to increase access to emergency transportation for rural and underserved Americans. Enacting the “Lower Health Care Costs Act” would instead exacerbate this rural health care crisis and greatly limit access to life-saving trauma care. Congress should:

  • Protect patients from balance bills AND from insurers seeking to deny claims for the most critically ill and injured patients.
  • Put the patient’s emergency medical needs first, not insurer profits.
  • Collect air ambulance cost data and rebase Medicare based on cost.

The provision also ignores congressional action within the last year to specifically address air medical balance billing issues. In the 2018 FAA Reauthorization Act, Congress established the “Advisory Committee on Air Ambulance and Patient Billing”, directing it to identify actions to “protect consumers from balance billing.” The Committee includes the Secretary of Health and Human Services and is designed to bring together all the relevant stakeholders and develop a solution that takes into account the unique economic, clinical, and operational aspects of emergency air medical services.