For air medical services, memberships should be a thing of the past

Patient billing is sure to be one of the most important healthcare-related issues of 2021. A recently heightened focus on billing practices, and a flurry of related activity in Washington, D.C., has put the issue top of mind for many as we head into the new year. This is certainly true in the emergency air medical industry.

For many years, emergency air medical companies have sold memberships to patients who rely on their services to access critical healthcare during emergencies. This subscription model was created to serve as an alternative to insurance, covering members for the cost of an air ambulance flight when a payer denied reimbursement for the transport. But in today’s healthcare world, this model is outdated, and it is time to move forward.

At Air Methods, we have identified more effective ways to keep patients out of the middle of the billing process. That is why we eliminated our membership program in 2019 and refunded all Medicare enrollees. For many years now, we have focused all our efforts on reaching in-network agreements with insurance companies. We have also developed a robust patient advocacy program that provides the assistance patients need after a transport so they can focus on their recovery rather than bills. And this model is reducing the out-of-pocket costs for our patients, which is now less than $200 including copays and deductibles.

Memberships are often sold on myths rather than facts. For example, people might believe if they do not have a membership with an air medical provider, they won’t be transported during a critical emergency like a stroke or heart attack. Or they are led to believe memberships replace insurance and cut out the concern of handling claims after an air ambulance transport. However, neither of these assumptions are true.

If an air ambulance is called to the scene of an accident or to transport someone in critical distress, it’s a true medical emergency. By definition, that means the patient needs immediate medical care or they might suffer long-term damage or die. A patient experiencing a medical emergency needs immediate care and is in no condition to request a specific air medical service or feel pressure to do so because they happen to hold a membership. Air medical companies should, at a minimum, reassure patients that they will be cared for no matter their financial situation, and least of all, whether they have a membership. If a membership negatively impacts that understanding and hinders medical care, it is time for a change.

Air Methods serves 49 states with more than 400 helicopters and fixed-wing aircraft executing approximately 65,000 time-sensitive emergency medical transports a year. When called by an independent physician or first responder, our crews have an asset deployed with our highly trained clinicians and pilots within less than 15 minutes.

The most common conditions that our air medical crews treat are cardiac, stroke, respiratory stress, or trauma from some type of accident. During these emergencies, each minute is crucial to the outcome of a patient. During the current global pandemic, our air ambulance crews have also transported over 4,000 COVID patients. As rural hospitals continue to close, we are the last line of defense to get patients to Level-1 and Level-2 trauma centers that can deliver the treatment these patients require.

The nature of emergency air medical transport means it is always a critical emergency, but the myth is still being purveyed that patients can use their air medical service memberships as a substitute for insurance. However, memberships are not regulated in most states, and even if a patient has a membership with the air ambulance company that transported them, they are still required to go through the insurance process. What’s more, Medicaid and Medicare Part B beneficiaries have never needed memberships because they are fully covered for air medical services – yet some air medical companies still target them in marketing campaigns to get these Medicaid and Medicare beneficiaries to spend their limited resources on memberships.

A membership is not a prerequisite for care, and it doesn’t replace insurance. That begs the question, is there really a need for them at all? The answer, in short, is no. Air medical services are provided in life-threatening situations when time is of the essence, and there is no time to “schedule” or “wait” for a transport.

An even greater indictment of this practice is that, historically, memberships have been sold using fear tactics. Patients are scared into thinking they will be stuck with a big bill and therefore need to buy a membership to avoid this imminent peril. The problem with this is, first, it uses scare tactics and, second, that message is coming from the same company that is transporting them, making the approach a bit like being both arsonist and firefighter. Obviously, this is the opposite of truly serving the patient to take them out of the middle.

Over the last four years, Air Methods has deployed multiple strategies to make billing as transparent and simple as possible for our patients. Our guiding principle is to approach any billing concerns according to what is best for them. To accomplish that, we have aggressively pursued in-network agreements with any willing payer who will come to the table and negotiate with us. This has resulted in over 50 percent of our privately insured patients being covered by in-network agreements – up from just 5 percent only four years ago – with partners like Anthem, Humana, and most states’ Blue Cross Blue Shield plans.

We have also been aggressive in our pursuit of partnerships with the largest national insurance companies – UnitedHealthCare, Aetna, and Cigna – but have yet to secure agreements with them. They remain the final pieces to the puzzle for us to reach our goal of being 100 percent in-network in the U.S. Being in-network is the best way to remove the financial burden from patients and ease the reimbursement process, and we continue to appeal to the “Big 3” insurance companies to come to the negotiating table.

Additionally, our patient advocates are individually assigned to patients with out-of-network payers, and a robust financial assistance policy has resulted in an average out-of-pocket cost of under $200 for all our patients. We do not balance bill patients and only send patients a bill if they have never provided us a payer of record or communicated with us to qualify them for financial assistance.

Most recently, on Dec. 21, 2020, Congress passed the Consolidated Appropriations Act (HR 133), which included the No Surprises Act. This legislation takes the patient out of the middle of the billing process between their healthcare provider and health insurance company by prohibiting balance billing and establishing an independent arbitration process to resolve any billing disputes.

The No Surprises Act eliminates once and for all the need for air medical memberships. This eliminates the pressure of receiving a large air medical bill. Plus, this new legislation and continued progress reaching in-network agreements show there is no need for any consumer to buy – or for any air medical service to sell – memberships. And if air medical companies say a memebrship is important to help with  copays and deductibles, we must question their commitment to actually going in-network and protecting all patients, not just those who pay more.

While Air Methods welcomes efforts by Congress to address surprise billing by passing the No Surprises Act, we still strongly believe that going in-network is the best solution to balance bills. We plan to continue our efforts to partner with any insurance company willing to negotiate in good faith. And when we finally get UnitedHealthCare, Aetna, and Cigna to resume negotiations with Air Methods to secure in-network partnerships and agree to fair reimbursement rates, our patients, who are their customers, will be taken completely out of the middle of the billing process.

The arsonist as firefighter sales tactic utilized to sell air ambulance memberships puts undue pressure on patients and doesn’t fully disclose the financial terms of the product they are purchasing, or the fact that it isn’t needed. This creates unnecessary and dangerous pressure on the patient to delay their care and wait for their “free” air ambulance transport based on whatever membership they might hold. It is a risk that patients who need time-sensitive air ambulance transport cannot afford to take. We encourage all air medical services that offer membership programs to end them, refund Medicare enrollees who never needed them, and adopt more effective practices. Also, we are supporting, and asking insurance companies and other medical providers to do the same, the effort at the National Council of Insurance Legislators (NCOIL) to regulate air medical memberships as supplemental insurance to ensure there is oversight of these products and that the patient is covered regardless of air medical service provider.

It is time for the air medical industry to evolve. 

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