Bills designed to curb huge air ambulance bills are set for hearing this week

Montana Standard (Butte)

Jan. 09--HELENA -- Lawmakers are set to hear two bills this week to help protect consumers who use air ambulance services from ending up with massive bills.

The 2015 Legislature passed a resolution to study the problem after hearing from Montanans -- most with medical insurance -- who were saddled with bills from $50,000 to more than $100,000 after air ambulance flights.

That study ending up consuming much of the time of the Economic Affairs Interim Committee, which generated Senate Bill 44, carried by Sen. Gordon Vance, R-Belgrade, and House Bill 73, carried by Rep. Ryan Lynch, D-Butte.

Air ambulances generally fall into three categories: hospital-based services that are a part of the contracts those facilities negotiate with insurance companies and providers; nonprofit operators that are affiliated with hospitals; and for-profit companies that may or may not contract with insurance. The two bills are meant to target the for-profit companies, which are new to the state.

There are 13 air ambulances operating in Montana; about half contract with at least some insurance providers. A sampling of 19 air ambulance bills received by Montanans and reviewed by the interim committee shows the average cost per flight on an out-of-network air ambulance was $53,397.

Vance and Lynch say they are carrying the legislation because people in their districts who took flights and later ended up with huge bills -- even though they had insurance -- called them for help.

"They have a job; they want to pay their bills and want to do the right thing," Lynch said. "They just thought they were taken care of, and they got balance bills of $50,000, $60,000, $70,000, and they were thinking bankruptcy, tapping their retirement."

"The federal government doesn't seem to either have the will or the ability to take care of it," Vance added.

Under Vance's bill, if a person who has health insurance uses an out-of-network air ambulance service, they cannot be billed for the difference between what the ambulance charges and their insurance pays. Insurance companies and ambulance companies have the option to dispute payment amounts to the Montana State Auditor, Securities and Insurance Commissioner, who governs insurance companies, for a review.

Lynch's bill seeks to regulate memberships sold by for-profit air ambulance companies by defining the agreement as an insurance contract. Approximately five ambulances sell memberships in the state.

Companies such as Reach Air Medical Services, which operates in Bozeman and Helena, sell memberships with the promise that the company will not send a bill to consumers with insurance for the difference between the ambulance charge and what their insurance company pays on the claim. A Reach membership is $65 a year for a household.

For-profit air ambulance companies have fought against becoming in-network providers, saying the rates insurance companies pay for flights do not cover the cost of the flights while some hospital-based services that are covered by insurance -- such as HELP Flight run by St. Vincent Healthcare in Billings -- say the rate is sufficient.

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To sell memberships, an air ambulance would have to be authorized by the commissioner. Companies would have to meet certain requirements such providing a map of the area they serve and any reciprocity agreements with other companies.

Air ambulances have argued that they are not medical providers but airlines and therefore are governed by the Airline Deregulation Act, not insurance laws. Last year a North Dakota law that created a priority list hospitals would use when dispatching air ambulance services was struck down by a federal judge who said it violated the ADA. To get on the list, ambulances had to enter into contracts with an insurance company.

Lynch said the two bills won't change much for hospital-based providers. "If you're doing the right thing, you're not going to have an issue. If you're not doing the right thing, then you're going to have to defend your business practices," he said. "The goal of this was to make sure air service remains in Montana. It's essential. It's a rural state."

Lynch said the bills are an opportunity to accomplish something this session that will help Montanans and is a possible bipartisan bright spot in a year that's expected to bring bitter battles along party lines over the state budget.

"There's a lot of bad news that comes out of Helena when the Legislature is in session, and with the budget the way it is, there's a lot of 'this program is going to get cut, this is going to get slashed,'" Lynch said.

"This is a policy piece that is completely outside the scope of the budget that truly impacts every community in Montana every day, and this is what the Legislature should be doing. We should be working together; we should be offering solutions that benefit communities and not poking each other in the eye."

House Bill 73 will be heard by the House Business and Labor Committee at 8:30 a.m. Tuesday in room 172 at the Capitol. Senate Bill 44 will be heard at 8 a.m. Tuesday by the Senate Business, Labor and Economic Affairs Committee in room 303.

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