Air ambulance and health insurance companies took turns blaming each other Thursday for costly but lifesaving air ambulance flights in Montana. The accusations flew during a legislative committee hearing.
Jesse Laslovich from the Montana insurance commissioner’s office told the committee to not buy into everything the companies were saying and to do what is needed to protect Montana consumers and patients.
“You’ve got to be bold. Your constituents are counting on it. And don’t give into this garbage, these threats.”
Laslovich also today filed as a candidate for the state auditor’s position.
Air ambulance bills often have a price tag in the five figure range. Patients' shock over the cost of emergency medical transport has recently turned into complaints filed to the auditor’s office.
Laslovich says Montana needs a law to protect against these giant medical bills.
“Let’s see what we can do legislatively. And if we get sued, you’ll be on the right side.”
Air ambulance representatives said the price of their services is based on the cost of having fueled aircraft, trained staff, and being ready to fly anytime they’re called.
Bill Bryant, a lobbyist for the air ambulance industry, said air ambulance rides in a rural place like Montana are especially costly because there’s not as much business as in urban areas.
Bryant says insurance payments need to reflect that extra cost.
“But the insurance companies want to pay the same rate to everybody, which makes about as much sense as trying to fit everybody into a size 7 shoe.”
Bryant also says patients are being left with a bigger bill because the benchmark payment rates set by Medicare aren’t keeping up with the cost of running an air ambulance business.
Air ambulance fees can run from about 400 to a 1,000 percent of what Medicare pays.
Bryant says some insurance companies make up their own rules for what they consider reasonable payment.
“It’s this scheme, plan, strategy, whatever you want to call it, from the insurance companies, that keeps them from paying these higher prices and shifts all that burden to the patients.”
Insurance companies in Montana say they pay in the 200 to 250 percent range of Medicare.
REACH Air Medical Services Representative Don Wharton said that rate isn’t realistic.
“And if we were to accept what has been offered in these negotiations, we would certainly not have a sustainable business.”
Industry representatives said one solution would be for insurance companies to accept full financial responsibility for air ambulance services, for everything beyond a patient's normal deductibles and co-payments.
The disagreement on what is considered reasonable expense for reasonable care leaves some air ambulance companies out of insurance networks. And that can leave patients with huge bills.
Todd Lovshin from PacificSource Insurance said REACH Air Medical Service simply does not negotiate with them on rates.
“They have not come to the table. They have not sat down with us and been able to negotiate any sort of rate. In fact we don’t ever get to the conversation about rates with them because they don’t return our calls, our emails or our letters.”
Connie Welsh of the Montana University System Health Plan also said air ambulance companies are being stubborn in not wanting to negotiate lower rates.
“We have seen that air ambulance companies that do not participate in-network more and more frequently are not wanting to talk to us. And I would say that in the last 2 years we have not had one single negotiation where we have had an air ambulance company willing to deal with us.”
Insurance company representatives recommended that medical transport companies disclose more of their pricing to hospitals, and said hospitals should work to use in-network ambulance companies when their patients need transport.
The Economic Affairs Interim Committee also heard from Amy Thomson. Thomson’s newborn daughter was in heart failure when she had her first experience with an air ambulance. The flight from Butte to Seattle billed at $56,000. At the time her insurance company, PacificSource, didn’t have an in-network air ambulance company near her family.
Thomson was skeptical of both insurance and air ambulance companies' efforts to negotiate fair prices.
“And so what I want to see is more coordination between these groups to take the burden off of families like mine, who will continue as they argue and refuse to negotiate be the ones who hold the burden of cost. And it was a 10 month long battle. I’m going to ask if you were given some rose colored glasses from Airlift Northwest and PacificSource about their negotiating together. It was my complaint, two of them to the state, that forced that negotiation.”
Around the time Thomson called a lawyer for help deal with her bill, she was told the her insurance company had worked with the air ambulance company to cover the full cost of the bill.
On Friday, the economic interim committee will discuss what potential steps can be taken to take lift the burden of expensive medical transport from Montana patients.