Air ambulance debate continues at Capitol

HELENA – Insurers and independent air ambulance companies on Thursday explained their costs to a state panel in a meeting capped off by a call from the chief legal counsel for the state insurance commissioner for the board to be “bold” in its action to address the problems.

The room was packed as the Economic Affairs Interim Committee continued its probe into air ambulance service in Montana in which people have reported bills as high as nearly $100,000 for being transported by the emergency aircraft not affiliated with an insurance network.

Insurers and members of the public said the private air ambulance companies have been unresponsive in dealing with billing queries.

Amy Thomson of Butte said her daughter was transported by air in January 2014 to Seattle. Then she got a bill for $43,000.

State panel looking at air ambulance costs, solutions

She went through three appeals with the insurance company and ultimately got a zero balance. But the memory of the 10-month battle still leaves her teary.

“You are not a commodity,” she said. “Your life is a right, not a privilege.”

The EAIC has been directed by House Joint Resolution 29, as passed by the 2015 state Legislature, to look into air ambulance services that want people to buy a membership or are not affiliated with insurers.

Earlier in the meeting, Bill Bryant of Sierra Health Group spoke for a coalition of air ambulance services, saying insurers need to adjust how they bill.

“Insurance companies want to pay the same rate for everybody, which makes as much sense as fitting everybody with a size seven shoe,” he said.

Chlorine gas leak in Harlem seriously injures employee

He encouraged the panel to create legislation to make the insurance companies responsible for all but the deductible.

“If they cannot decide what is fair and reasonable, I am sure a judge would let them know,” he said.

Don Wharton, representing for-profit air ambulance company REACHAir, said he supported transparency and that insurance companies should post allowable rates online. He also said Medicaid was “woefully” under the cost of providing emergency services.

However, Todd Lovshin of insurer Pacific Source said some of the problem lies with the private air ambulance providers not returning calls, emails or letters to discuss rates.

Other insurers and members of the public also said the private air ambulance companies were unresponsive.

Connie Welch of the Montana State University Health Plan said air ambulance companies not in the insurance network refuse to talk or return calls.

“At the end of the day, I need an insurance company to call me back,” she said.

Welch knew of an incident in which two air ambulance companies raced to the scene and both billed for responding to the call.

Just Humphrey of Dillon said it took him as many as eight calls to get information on rates.

“That is not transparent,” he said, adding “It’s the only business I know of where you can take advantage of people in poor health and they don’t get an option.”

According to a recent survey, 13 air ambulances have been licensed by the state that follow three models: hospital based or “traditional” a not-for-profit in which a hospital controls the business; the second is hospital affiliated not for profit; and the third is for profit.

Ten of those 13 companies responded to the EAIC survey. Of those, five are in an insurance network, three said one-quarter to one-half of their flights had insurance to cover costs and five said they accept Medicare.

Officials say it is the companies outside insurance company networks where the problems are occurring.

The EAIC took no action after the hearing, but Jesse Laslovich, chief counsel for the state insurance commissioner’s office, urged members to develop a game plan.

“We have to start narrowing our options and put solutions on the table,” he said. “This discussion has really exposed how broken the system is.”

He said the air ambulance companies have “their hands around our necks.

“You guys need to be bold; if you get sued, you’ll be on the right” side, he said.

Officials say the Airline Deregulation Act of 1978 has made it difficult to come up with workable legislation. It also left states with no jurisdiction, officials said.

The membership program in Montana was approved by the state Legislature in 2011 with Senate Bill 278, when, according to a study given to the committee, it exempted some private air ambulance services from insurance law. They had to have operated in the state for at least two years.

According to a survey from the state of the 13 air ambulance providers, in 2014 they flew 1,428 missions in-state with fixed wing aircraft, or airplanes, and 1,133 with helicopters. During that same time period they flew 386 out-of-state missions with airplanes and four with helicopters.

They had liftoff rates that ranged from $8,596 for an airplane to $15,426 for a helicopter. Mileage rates ranged from $26 for an airplane and $133 for a helicopter.

Services offering memberships are an easy way to protect people from large out-of-pocket expenses, proponents say.