On Monday, December 21, 2020, the U.S. Congress passed, with the President signing on Sunday, December 27, the Consolidated Appropriations Act (HR 133), which included the No Surprises Act. The No Surprises Act takes the patient out of the middle of the billing process between their health care provider and health insurance company – by prohibiting balance billing and establishing an independent arbitration process to resolve any billing disputes.

The following is a statement from Air Methods on the passage of the legislation:

Air Methods has long supported policies that take patients out of the middle of the emergency healthcare billing process, and we have worked to develop such solutions through innovations like our robust Patient Advocacy program and our efforts to go in-network with payers around the country. In addition, we have been active members of the congressionally created Department of Transportation Air Ambulance and Patient Billing (DOT AAPB) Advisory Committee to work toward fair and equitable solutions to surprise billing.

To that end, we appreciate and welcome efforts by Congress to address surprise billing by passing the No Surprises Act. Along with collaborating with stakeholders through the rulemaking process, we look forward to our continued work with the DOT AAPB Advisory Committee and hope the final recommendations from that group provide additional guidance for regulators in their decision-making process.

We are prepared to work with lawmakers on a variety of solutions addressing claims that are denied by insurers. One key concern for Air Methods is the possibility of tying reimbursements to a median in-network rate that uses inaccurate benchmarks and does not adequately compensate emergency air medical companies for their services. It is also important that this legislation does not nullify the great gains we have made in reaching in-network agreements with many payers around the country, which has made a huge impact on taking patients out of the middle of the billing process. We also strongly support policies that promote more robust data collection, which will allow for fair in-network reimbursement rates.

Air Methods still believes going in-network is the best solution to balance bills. As we have for the past 18 months, we will continue to partner with any insurance company willing to negotiate in good faith. We encourage the largest national insurance companies – UnitedHealthcare, Cigna, and Aetna – to come back to the table to resume negotiations with Air Methods to secure in-network partnerships. If they agree to fair reimbursement rates, then Air Methods will be nearly 100% in-network for all our commercially insured patients.

This legislation also eliminates once and for all the need for air medical memberships. In the past, air medical memberships were sold under the guise as a way to protect consumers from large air medical bills. However, this new legislation and continued progress reaching in-network agreements show there is no need for any consumer to buy – or for any provider to sell – memberships. We encourage all providers that have membership programs to end them and adopt more effective practices. The surprise billing legislation passed today illustrates the need for the air medical industry to evolve.


No Surprises Act

What the Legislation Does:

• Prohibition on balance billing patients.

• Open negotiation process between insurer and provider.

• Independent Dispute Resolution (IDR) process – a “baseball-style” arbitration. Data collection on the costs of providing air ambulance services as well as on air ambulance quality and claims data submitted by insurers.

• The establishment of an air ambulance advisory committee through the Department of Health and Human Services and the Department of Transportation to examine issues related to air ambulance clinical capabilities, vehicle types, and triage criteria

What IDR Arbiter “Shall Consider”:

• The qualifying payment amount defined as – the median of the contracted rates recognized by the plan…(determined with respect to all such plans of such sponsor or all such coverage offered by such issuer that are offered within the same insurance market) as the total maximum payment (including cost share amount) for the same or similar service that is provided by a provider in the same geographic region.

• Quality & outcomes measurements of the provider

• Acuity level of the patient

• Training, experience, and quality of the medical personnel

• Aircraft type, including the clinical capability level of the aircraft

• Population density of the pick up location (urban, sub-urban, rural, or frontier)

• Demonstrations of good faith or lack of good faith efforts to go in network by payer provider

• If applicable, contracted rates between the provider and plan during the previous 4 years.