What States Can Do to Address Out-of-Network Air Ambulance Bills
J. L. Med. & Ethics vol. 48, pp. 462-473 (2020)
21 Pages Posted: 4 Nov 2020
Date Written: 2020
Out-of-network air ambulance bills are a pernicious and financially devastating type of surprise medical bill. Out-of-network air ambulance bills often affect consumers in rural areas who may need air transport to reach remote hospitals in an emergency, but they also can affect patients who need rapid transport between hospital facilities. The vast majority of air ambulance transports are out-of-network with the patient's health insurance plan, and in an emergency, the patient is unable to negotiate or choose an in-network air ambulance provider or decline the services. Even if the patient's health plan pays a part of the bill, the air ambulance provider may balance-bill the patient for the difference between their full charges and the amount paid by the patient's insurance, typically tens of thousands of dollars. Despite bold state efforts to protect consumers from out-of-network air ambulance bills, courts have broadly interpreted the Airline Deregulation Act to preempt most state attempts to regulate air ambulance billing abuses, so a federal solution is ultimately needed. However, in the absence of a federal fix, states have experimented with a variety of approaches that may survive preemption and provide some protections for their citizens. Having separately written about what federal policies Congress should pursue, this article focuses on what states can do to protect consumers from out-of-network air ambulance bills. These state solutions include: (1) establishing a public or nonprofit air ambulance service to compete with for-profit providers; (2) prohibiting balance billing by air ambulance providers; and (3) regulating dubious air ambulance membership programs.
Keywords: medical cost, health insurance, out-of-network medical costs, air ambulance, preemption, health law, federalism
Suggested Citation: Suggested Citation