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The Association of Air Medical Services has filed a lawsuit against the federal government challenging the No Surprises Act, arguing that the new law gives insurance companies the upper hand in payment disputes and could threaten the future viability of air medical transport.
AAMS supports the basic goals of the new law, which aims to shield patients from surprise medical bills, including balance billing from emergency medical transport providers and remove them from the dispute process that often results between healthcare providers and insurance companies.
Taken as a whole, the No Surprises Act is meant to make healthcare costs more transparent, and avoid sticking patients with expensive bills for air ambulance transports when the provider is not included in the patient’s insurance “network.”
Most air medical transport providers agree that the system should be more transparent, but there is pushback from some provider advocates who see the rules as favoring insurers over air medical operators. Others in the industry say that’s not the case, that patient welfare is the ultimate goal and that air medical billing practices should have greater regulatory oversight.
The new law affects all of healthcare, but has particular ramifications for the air medical sector, said Brian Stimson, a former U.S. Department of Health and Human Services acting general counsel and principal deputy general counsel and now an attorney representing AAMS.
“It does a lot of different things,” Stimson said at the recent Air Medical Transport Conference (AMTC) in Fort Worth, Texas. “It touches a lot of different parts of healthcare and air ambulance is just one part. In concept, it holds patients harmless from balance billing. Patients are to pay no more than in-network cost sharing . . . determined based on something called the recognized amount, which is determined by state law.”
At issue is a provision in the latest set of interim final rules (IFR) for implementation of the No Surprises Act that lays out an independent dispute resolution process that allows both healthcare providers and insurance companies, after a period of negotiation, to plead their case for payment before an independent arbitrator.
While it “was the intent of Congress when passing this law that no single statutory factor receives special weight in the . . . process,” AAMS said in a statement announcing its lawsuit, the interim final rules “ignore Congress’s intent, instead focusing on a single factor.”
“Air Medical Services transport the sickest, most severely injured patients in our healthcare system — we fully support protecting those patients from these payment disputes and worked with Members of Congress and our larger healthcare community partners to ensure that happens,” AAMS president and CEO Cameron Curtis said in a statement. “However, the fair and transparent process that we all supported is not the process being implemented. Instead, we are faced with a scenario in which a patient is in an emergency, is transported by a helicopter at the request of a trained first responder or qualified physician, and that patient’s insurer gets to unilaterally determine the amount they pay. This will have disastrous consequences for access to emergency air ambulance services.”
That factor is the qualified payment amount (QPA) or the insurance company’s median in-network rate for certain contracts for a given service — in this case air medical transport — in a certain area. In-network cost sharing is either determined by the state-specific recognized amount or by a QPA, Stimson said.