OPINION: Air ambulance billing problems must be solved

We write to you today on the issue of preventing excessive air ambulance balance bills from the perspective of the hospital-based air ambulance services that have operated within our great state over the past 30-plus years. 

There has been a flood of information put out to the public concerning the very complex topic of the cost and coverage of air medical transport within Montana. Among it, several examples have been shared of patients who have faced debilitating bills, upwards of $30,000, from air ambulance companies despite having health insurance. This is a very concerning issue, about which we had heard little in the state until recent years.

There’s a reason for that—it wasn’t happening regularly in the state of Montana before 2009.

Before 2009, most of the air ambulance services operating in Montana were hospital-based, meaning they are programs operated by local Montana not-for-profit hospitals, such as Benefis Health System and Kalispell Regional Medical Center. There are currently four such programs in the state. Since 2009, however, a new model of delivery for air ambulance services emerged in our state. These new companies are referred to as “community-based” programs, and they are often for profit.

The emergence of these stand-alone, for-profit air ambulance programs introduced a new dynamic and billing situation that was previously unseen in Montana.

The issue this ultimately brings to the forefront for Montana’s elected representatives to consider is how much a patient should be responsible for when an air ambulance transport is needed. And, those services frequently are needed in a frontier state like Montana.

While many uninsured patients often benefit from charity care programs that alleviate the financial stress that could accompany a large air ambulance transport bill, patients with insurance are often the ones who are balance billed by the stand-alone programs.

It is shocking to many Montanans to learn that you can have insurance but still be left with a $30,000-plus bill. We agree — it is unconscionable. To help you understand how this is possible from some — but not all — air ambulance companies, let us explain:

Balance billing occurs when the air medical program that picks up the patient has not entered into a contract with the patient’s insurance company. The two stand-alone programs currently based in Montana have not contracted with Allegiance or BCBS of Montana and other insurance companies.

Because there is no contract or previously negotiated relationship, the air ambulance bill is treated as out of network. Being out of network does not mean patients are uncovered by their insurance, but rather means the stand-alone air ambulance company can bill them for any balance not paid by the insurance company. Given that patients often have very little, if any, say over who comes to transport them in a medical emergency, patients have little choice in whether they receive an air ambulance that contracts with their insurance company and thus protects them from large balance bills.

In short, balance bills are the difference between what the air ambulance company charges and what the insurance company pays. So, if a patient has a $50,000 charge and the insurance company agrees to pay $18,000, the patient is sent a balance bill of $32,000.

Some of the balance bills that have been presented to the Legislature are in excess of $50,000. The highest balance bill seen during committee testimony was over $270,000 — far more than the average home price in Montana.

Large balance bills have the potential to destroy people’s lives, and the hospital-based programs do not take this lightly. We, as a state, need to take action to protect our residents from large balance bills. As hospital-based programs, we have survived for decades without passing these devastatingly large bills on to our patients and have maintained the ability to continue offering top-quality care to people in their time of need. In virtually all cases, the hospital-based programs do indeed contract with our Montana insurance companies.

We, as hospital-based programs, are doing our part to address this issue by participating in the Economic Affairs Interim Committee Air Ambulance Working Group. Our goal is to help find a resolution that allows all Montanans to have both access and affordability.

The issue is not whether all Montanans need access to air ambulance services — that is a given in our state. This issue is how we sustain these critical, life-saving services without destroying the lives of those we save.

Coryell is executive director of Aviation Services, Kalispell Regional Healthcare. Schandelson is manager of Benefis Emergency Services & Mercy Flight in Great Falls.