As part of the Consolidated Appropriations Act of 2021, which was signed into law on December 27, 2020, Congress saw fit to pass what has been dubbed the No Surprises Act. This act led the Department of Labor and two other federal agencies to propose rules for reporting air ambulance services and their cost. Over a year later, no final rule has been issued. But employers, their health insurance carriers, and their third-party administrators should keep watching.
The air ambulance rule was the result of language in the original bill mandating that federal agencies find ways to ensure that consumers are not hit with surprise medical bills. A number of other rules to that effect have already been implemented. It is not clear why the proposed air ambulance rule still has not been implemented more than a year after it was introduced.
What the Rule Does
The air ambulance rule mandates that “group health plans (including ACA grandfathered plans) and health insurers are required to report air ambulance services,” according to a recent post on BenefitMall. BenefitMall is a Dallas-based general agency representing more than one hundred insurance carriers as well as thousands of brokers around the country.
They explain that most employers would be unable to meet reporting requirements under the proposed rule because they do not have access to such information. So instead, BenefitMall recommends that they enter written agreements with their carriers or plan administrators to handle reporting for them. A written agreement would put the onus on one of the other entities to report air ambulance services.
Why the Rule Is Necessary
The rule is necessary under the No Surprises Act because Congress specifically mentioned costly air ambulance services in its legislation to prevent surprise medical bills. Federal agencies were mandated by the law to propose and finalize rules to that effect. So why did Congress include the language?
It is not uncommon for insurance carriers to either limit the amount they will pay for air ambulance services or not cover them at all. Someone in need of an air ambulance is probably in no state of mind to understand the financial obligations associated with such service. Therefore, being able to turn down the service due to affordability concerns really isn’t an option. But that can mean only one thing when a patient’s insurance doesn’t cover the costs: a surprise medical bill.
According to some estimates, as many as 69% of all air ambulance transport services are provided out-of-network. The result of such services is often a patient bill of upwards of $35,00-$40,00. Most of us would be surprised by an unanticipated bill of a few thousand dollars. Imagine getting a bill for tens of thousands of dollars for a service probably necessary to save your life.
Air Ambulances Aren’t Cheap
The long and short of it is that air ambulance services do not come cheaply. It is no wonder insurance carriers do not want to bear the full cost of paying for them. But let’s be honest. Why do people pay so much money for health insurance anyway? If a person’s policy will not fully cover catastrophic events, what are they really getting for the money?
At any rate, the new rule has not been finalized. That means the first deadline dates – March 31, 2023 and March 30, 2024 – are still up in the air. It is a virtual guarantee that the 2023 deadline will come and go. The 2024 deadline could be salvaged if the rule is finalized at some point this year. We will have to wait to see what happens.
