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Wieland moves to address air ambulance costs billed to insured patients


JEFFERSON CITY, Mo. — A bill moving through the Missouri General Assembly aims to reduce the too-often exorbitant costs of air ambulance transportation.

Sen. Paul Wieland’s SB 267 has already gotten the stamp of approval from the Senate, and the House has begun vetting the bill. On Monday, the House General Laws Committee held a public hearing on the proposal.

The issues at hand, according to Wieland, are the thousands of dollars fully-insured Missourians are paying for air medical transportation.

In January, the Missouri Department of Insurance, Financial Institutions, and Professional Registration released a report detailing the high-cost patients are left with after a medical emergency. According to the report, air ambulance companies billed Missourians nearly $26 million for services in 2017 and — after coinsurance, copays, and deductibles — patients were on the hook for $12.4 million.

Air ambulance services nationwide doubled between 2010 and 2014, from $15,000 to $30,000 per transport, according to a 2017 report. The U.S. Government Accountability Office noted the price index increased by 8.5 percent.

“Right now in Missouri, our fully insured constituents are left holding large medical bills they cannot afford,” said Wieland.

He wants to fix that.

But the main obstacle to a solution with air ambulance providers is they fall primarily within federal jurisdiction, leaving the state with almost no options. So, Wieland is looking to give his constituents and all Missourians leverage when it comes to bills.

Current law requires insurance companies pay ambulance services directly to ambulance service providers or emergency medical response agencies. SB 267 modifies that provision and restricts payment to ground ambulance services, which will exclude air ambulances from direct payment requirements.

“The result of this will be that insurance companies will pay our constituents the insurance providers portion of the bill and the constituent will then have leverage to negotiate with the air ambulance company,” said Wieland. “The goal of passing SB 267 and removing the direct pay requirement is to encourage more air ambulance companies to join insurance networks and provide more coverage and protect our constituents.”

The measure is supported by the American Health Insurance Companies, the Missouri Insurance Coalition, and St. Louis Area Health Coalition.

The measure did receive pushback from those in the air medical transportation business who argued this could actually hurt the patient instead of helping them.

“The purpose of having insurance is for them to negotiate with the air ambulance company on your behalf,” said a representative from Airvac.

He pointed out this bill would allow the insurance company to sign a check for what they think the claim is worth and then leave the insured to deal with the air ambulance company. In doing so “the patient may end up paying more money,” he added.

All air ambulance companies have fixed costs, he stated. They have to have transportation and a pilot ready to fly out on a moments notice — 24 hours a day, seven days a week, and 365 days years — which translates into higher costs for the patient.

One lawmaker raised the possibility of excluding air medical transportation already in an insurance network, like a majority of hospital-based air ambulances. Wieland noted he would be open to the conservation.