Health Affairs study points out problems with balance billing, but doesn’t address entire issue

Health Affairs study points out problems with balance billing, but doesn’t address entire issue

April 27, 2020
JaeLynn Williams
By JaeLynn Williams

This week, our team read with interest a study titled, “Most Patients Undergoing Ground And Air Ambulance Transportation Receive Sizable Out-Of-Network Bills,” that was published by Health Affairs on April 15. While it examines balance billing from one point of view, it is important to provide thoughts from the perspective of an emergency air ambulance provider that has first-hand experience with the issue.

During the past several years, and before any legislation was considered, Air Methods has certainly recognized the problem of balance billing in our industry and has enacted a variety of strategies to take patients out of the middle of this complicated process. A key initiative has been our work to partner with insurance companies all over the country to reach in-network agreements. This has proven to be the most effective way to ensure patients do not have to deal with unexpected charges.

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The average out-of-pocket cost for our patients amounts to just a little over $200. This data set is completely absent from the study, as is any acknowledgement of the provider’s attempt to resolve the claim. Our prevailing tendency, through our Patient Advocacy process, to forgive the balance left by the insurance company contradicts much of the premise in this study.

The Health Affairs study states that, “legislation at the state and federal levels is being considered to protect patients from these ‘surprise bills,’ defined as out-of-network charges.” While these legislative efforts are underway, Air Methods has proactively and independently worked with insurance companies and has reached agreements with 54 health plans to date.

Our goal is to be 100 percent in-network nationwide. In-network coverage offers health plan members a discounted, out-of-pocket payment for qualified services, which varies depending on their plan’s benefits. It is important to note that health insurance companies control who is “in-network” for their plans, and, unfortunately, some of the largest national payers, United Healthcare, Cigna and Aetna, have been unwilling to add Air Methods as an in-network provider at rates consistent with what they are already paying today.

Another key detail in the Health Affairs study is its frame of reference, which does not take into account work that has been done over the past three years (all data is from 2013 to 2017). The gap in data from 2017 to present is particularly significant to Air Methods, as we have made a great deal of progress in eliminating balance bills during the past three years – going from just 6 percent in-network to nearly 50 percent today. This means that more than 80 percent of the population is covered for Air Methods’ services either through commercial insurance or through Medicare or Medicaid so they will not receive a balance bill for services. Once these final three large national payers I mentioned above allow us to be in-network, we will, for all intents and purposes, be very close to our 100 percent goal and have the ability to eliminate balance bills.

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