On Saturday, April 17, 2021, Chris Myers, Air Methods Executive Vice President of Customer Experience, Reimbursement, and Strategic Initiatives, testified before the NCOIL Health Insurance & Long Term Care Issues Committee regarding the NCOIL Model Act regarding Air Ambulance Protections Draft. The following is the complete text of his testimony with presented materials. The hearing can be viewed here on the Committee web page.

Chair Hunter, Vice Chair Ferguson, and Members of the Committee, my name is Chris Myers. I am the Executive Vice President of Reimbursement for Air Methods and I am glad to be back with you today. Thank you for the opportunity to appear before you to continue our discussion on this important topic. Since we last met, there has been a key development that directly affect this Model Act, and how consumers interact with membership products: The No Surprises Act was voted into law and will become effective on January 1, 2022. This law significantly changes the landscape of the U.S. healthcare system and dramatically decreases the financial risk for patients, as it prohibits the practice of balance billing.

To be clear at the outset, I am not here today to argue for the prohibition of memberships but, instead, for the appropriate regulation of them so that consumers are not deceived by what they are purchasing. Air Methods continues to believe that the best way to solve for the patient financial burden is to go in-network with payers. We have led the industry in doing just that and have in network agreements with almost every major payer in every state and continue to work hard to get the big three payers – Aetna, United, and Cigna – into network as well.

The implications of the No Surprises Act make this Model Act even more important because:

  • Memberships are largely obsolete starting January 2022, as they have been marketed to cover patients’ financial exposure to balance bills, which, again, will be prohibited in less than nine months. These products are now marketed to cover only copays and deductibles. One must ask how does this factor into the federal government’s prohibition on the routine waiving of copays and deductibles under the False Claims Act, Anti-Kickback Statute, and Civil Monetary Penalty Law?
  • Given emergency air medical transport is always bookended by a continuum of care, any value to consumers in covering copays and deductibles is actually determined by the insurer, subject to when an air ambulance claim is submitted, and what amount of financial responsibility remains on a consumer’s policy.
  • Memberships offer far less financial value to consumers now than they did previously since they only cover copays and deductibles.
  • Companies that sell memberships believe these products operate above state law; however, states can, and do, regulate air ambulance membership subscriptions. Good examples of this are FL, NY, and most recently WV. Importantly, there are several areas of consumer protection for state regulators to consider:
    • Payment-to-cost ratio decreasing – will consumers be charged fair premiums?
    • Interaction of memberships with the patient’s main health insurance policies. How will regulators ensure that these products add financial value for the policyholder and are not merely duplicative coverage?
    • Sales of memberships to consumers who have no real need to purchase them. We already know that 35% or more of consumers who purchase these are Medicare beneficiaries. When comparing the data provided to NCOIL with data from NAIC and AHIP on the U.S. Medigap market, the largest membership product in the United States, AirMed Care Network, is technically the second-largest Medigap product sold in the U.S., second only to United Healthcare, but without any regulatory oversight at the state or federal level whatsoever. What about the additional consumers who truly will not have any out-of-pocket financial risk starting in January because of the No Surprises Act?
    • Because membership policies are completely unregulated, there is no state or federal oversight to prevent consumers from being taken advantage of in the case of being sold membership policies by fraudulent companies. Last time I spoke to the Committee, we discussed HeliMedic, which masquerades as an air ambulance provider and air carrier but doesn’t seem to actually exist. Yet you can google their website right now and buy a membership from them that claims to cover you and your family anywhere in the United States.
    • Confusing and deceptive practices buried within the fine print of memberships should be reviewed to determine if they are truly in the best practice of the policy holders. For example:
      • Disclosures for Medicaid and Medicare beneficiaries shifts the burden to the consumer to certify they are Medicaid beneficiaries. What about adding disclosures for the No Surprises Act?
      • Membership contracts sign away the consumer’s first lien rights so that any settlement received from auto or homeowners insurance must first go to pay the full billed charges of the air medical bill.
      • Terms & Conditions allow for auto-renewals in perpetuity without consent or refunds.
      • How will consumers that realize they can no longer be balanced billed next year be able get a refund after the No Surprises Act is enacted, and to which state agency do they go for recourse if they cannot get a refund?
      • Some of the policyholders have been so scared by the potential financial burden of a balance bill that they have delayed care to be transported by their membership provider in a medical emergency versus the closest and most appropriate provider.

Memberships are indemnity products.

  • Copays and deductibles are set by a third party, the payer, not the provider.
  • In fact, a January 6 handout entitled “HR 133/Membership Matters Talking Points,” GMR states: No air company can predict individual out-of-pocket costs as those are determined by insurance companies.
  • Indemnifying the policyholder against costs determined and set by third-party entities is dispositive of the “insurance” question: air ambulance memberships engaging in this activity clearly fall within the business of insurance.
    • The data filed in Air Evac v. Dodrill in February 2021 shows that these products are pooling risk like an insurance product, not prepaying for services.
    • The patient cannot call an air ambulance and has no choice in the matter, for a membership to be considered prepayment, the consumer has to have a reasonable expectation that they will use the product.
    • Yet, you and I have a higher likelihood of dying of heart disease than we do of being transported by an air ambulance. Air Evac v. Dodrill showed similar utilization among consumers who had purchased an air ambulance membership. In this case, 0.2% of these individuals in West Virginia used their membership.
  • There has been a lot of confusion about the recent Appeals Court decision in Guardian Flight v. Godfread in the 8th Circuit. State legislators and regulators have been told that this decision prohibits them from taking any action on regulating memberships because of the Airline Deregulation Act. However, this is not completely accurate. Guardian Flight found that a state law enacted “for the purpose of regulating the business of insurance” falls under the reverse preemption of the McCarran Ferguson Act, 15 U.S.C. § 1012(b). Hence, legislation like the proposed NCOIL Model Act on Air Ambulance Memberships, including the amendment before you today, are permissible and appropriate, ensuring meaningful consumer protections for air ambulance membership products.
  • The proposed NCOIL Model Act, and the amendment before you, takes a targeted, narrow approach to appropriately regulate the business of insurance, and to protect consumers from predatory marketing and sales tactics.

If memberships are simply a prepaid service then they should be just that, and the economics should support it. However, after January 1, 2021 the only possible prepayment is for the copayment and deductible. It is important to remember that based on the timing of service or when the claim is filed that there may be no copay or deductible. Additionally, when the provider seeks reimbursement for these services from a third party, then they become a medigap product.

One final point to make is that there are much better ways to reduce the financial burden that a patient may face. At Air Methods our average out of pocket expense for all patients is less than $165. And in the case where an individual cannot afford to pay that amount we use specific financial information from the patient to qualify them for an appropriate discount.

We continue to support this proposed Model Act, and the amendment before you, as a way to give States a tool to help consumers, and to ensure that the coverage they are buying is not duplicative or deceptive. The proposed NCOIL Model Act takes a targeted, non-prohibitive approach to appropriately regulate the business of insurance, and to protect consumers from predatory marketing and sales tactics.

What is NCOIL?
NCOIL is the National Council of Insurance Legislators. From the NCOIL website:
NCOIL is a legislative organization comprised principally of legislators serving on state insurance and financial institutions committees around the nation. NCOIL writes Model Laws in insurance, works to both preserve the state jurisdiction over insurance as established by the McCarran-Ferguson Act seventy-four years ago and to serve as an educational forum for public policy makers and interested parties.
NCOIL works to:
• Educate state legislators on current and perennial insurance issues
• Help state legislators from different states interface effectively with each other
• Improve the quality of insurance regulation
• Assert the prerogative of legislators in making state policy when it comes to insurance
• Speak out on Congressional initiatives that attempt to encroach upon state primacy in overseeing insurance
NCOIL is an adamant, vocal opponent of any Congressional initiative that would deprive consumers of key state protections, preempt state laws that respond to unique insurance markets, threaten critical state premium tax revenue, and, in many cases, lead to cherry picking and fraud.

Materials used during Myers’ presentation:
PowerPoint Presentation
AMCN Brochure with Terms & Conditions

New collaboration with Baylor Scott & White Health will provide community with access to critical care through fast and reliable air medical transports

(GREENWOOD VILLAGE, Colorado, April 01, 2021) (GLOBE NEWSWIRE) – Air Methods, the leading air medical service in the U.S., is collaborating with Baylor Scott & White Health to open a base in Waco, Texas, on April 1, as AirLift Texas. The base will provide emergency air medical services to Temple and Bell County; Waco and McLennan County; Falls County and Coryell County.

“We are proud to work with Baylor Scott & White and will bring the highest quality of medical care to our patients in central Texas,” said Shane Farmer, vice president of customer experience, Air Methods. “In emergency situations, minutes can be the difference between life and death. Air medical services ensure fast and efficient transport with the best clinicians and pilots in the industry.”

The AirLift Texas Waco base is located at the Waco Regional Airport, 7909 Karl May Drive and will provide emergency air medical services 24/7/365 to the region, responding to emergency medical calls for trauma events such as heart attacks and strokes, pediatric emergencies, and other incidents, as well as critical interfacility transports.

The AirLift Texas air ambulance helicopter is an EC145 twin-engine light utility helicopter staffed with industry-leading trauma clinicians and pilots with years of experience in the field and will carry lifesaving blood and plasma on every flight. Skilled aviation mechanics ensure the aircraft is always safe and mission ready.

Air Methods and AirLift Texas adhere to strict COVID-19 protocols that include full personal protective equipment (PPE) for crews and decontamination of the aircraft after every transport. The base is committed to treating and transporting any patient who requires care.

During missions, air medical teams execute lifesaving interventions to care for patients, from providing trauma care after an accident to administering clot-busting medications after a major stroke. The clinical support and speed of transport is critical to ensure patients receive the best and most timely treatment possible. This includes transportation of COVID-19 patients throughout the region. All patients who are transported by AirLift Texas also have access to robust patient advocacy services to assist with the post-flight billing process so that they can focus on their recovery.

“As an in-network provider in Texas with a robust patient advocacy team to help patients navigate post-flight insurance requirements, it is our goal to keep our patients’ out-of-pocket expenses low,” said Kelly Shepherd, regional sales director, Air Methods. “And we do this, unlike many other air medical companies, without ever requiring or asking anyone to purchase air medical memberships, which are both an unnecessary and unregulated expense for any Texan.”


About Air Methods
Air Methods is the leading air medical service, delivering lifesaving care to more than 70,000 people every year. With nearly 40 years of air medical experience, Air Methods is the preferred partner for hospitals and one of the largest community-based providers of air medical services. United Rotorcraft is the Company’s products division specializing in the design and manufacture of aeromedical and aerospace technology. Air Methods’ fleet of owned, leased or maintained aircraft features more than 450 helicopters and fixed wing aircraft.

Media Contacts:                                                                                                    
Doug Flanders
VP Corporate Communications, Air Methods

Matt Pera
Amendola Communications for Air Methods
(219) 628-0258

It started out like any other day in the COVID-19-driven, work-from-home world of early 2020. Donna Smith, a systems analyst at health plan provider Anthem, Inc., was on yet another of a seemingly endless series of online meetings when she suddenly started feeling ill. Sweating profusely and with a wave of nausea washing over her, she left the meeting to lay down in the washroom, hoping the coolness of the hardwood floor would lower her temperature and settle her stomach.

When her symptoms persisted, she called out to her husband to dial 9-1-1 as she thought she might be having a heart attack. When the paramedics arrived, they first suggested she was having a panic attack. But after running several EKG tests they realized they couldn’t rule out a heart attack, as the symptoms for both are very similar.

Normally, someone in this condition would be taken to the local hospital by ambulance. But because the paramedics and emergency department physicians at the hospital weren’t sure of the cause or severity of Smith’s illness, it was recommended that she go to the VCU Medical Center in Richmond, Virginia where she could receive more advanced emergency care.

The challenge was VCU Medical Center is roughly a 50-minute ride by ground ambulance from her home nestled in a bucolic, rural area on the banks of the Rappahannock River – time the physicians and paramedics were concerned Smith didn’t have. So the decision was made to call Air Methods for an air transport.

The helicopter met the ambulance at the helipad that sat a few hundred yards from the rural hospital, and Smith was transferred onto it for what would be her first – and she hopes her last – helicopter ride.

“I was afraid, both for my situation and for the ride, but the Air Methods paramedics were great,” Smith said. “They calmed me and explained what was going on, what would happen when we took off, and kept me informed and comfortable the whole way – even to the point of handing me an air sickness bag when I needed one despite the motion sickness medication they had given me. They couldn’t have been kinder or more professional.”

After being examined at VCU Medical Center, the doctor there confirmed that Smith had “only” experienced a severe panic attack. Her husband, who had driven there separately, then took her home; Smith did not have to spend a single night in the hospital.

Often in a situation like this there would be a risk of a second panic attack, not from medical conditions but as a result of the bill left for our patients by the lack of coverage from their insurance. But that wasn’t the case this time, because to her delight Smith found that emergency air transport is an in-network benefit on her health plan.

“Everything worked the way it should,” Smith said. “I received the explanation of benefits (EOB) and the bill within a couple of days of each other. Both showed that my health insurance picked up the bulk of the cost without question. My patient portion was a little more than $3,000, which I paid by credit card after calling Air Methods. The process couldn’t have gone more smoothly.”

Smith feels fortunate that everything worked out the way it did.

“This event could have been much more serious than it turned out to be,” she says. “Had it been a heart attack, given where I live, the availability of air transport could have meant the difference between me enjoying the long retirement my husband and I planned when we moved into this home and him being left alone. I am thankful that Air Methods was a covered benefit on my plan, and strongly believe it should be included in every health plan.”

At Air Methods, we have made it our mission to identify more effective ways to keep patients out of the middle of the billing process. We eliminated our membership program back in 2019, focused our efforts on reaching in-network agreements with insurance companies, and developed a robust Patient Advocacy program that provides the assistance patients need after a transport so they can focus on their recovery rather than bills.

For many years, emergency air medical companies have sold memberships to patients who rely on their services to access critical healthcare during emergencies. This subscription model was created to serve as an alternative to insurance, covering members for the cost of an air ambulance flight when a payer denied reimbursement for the transport. But, in today’s healthcare world, this model is outdated, and it is time to move forward.

As patient billing becomes a top-of-mind issue in 2021, we have not wavered in our commitment to this model that is reducing out-of-pocket costs for our patients, which is now less than $200 including copays and deductibles.

Becker’s Hospital Review recently published an article by our CEO, JaeLynn Williams, calling on the air medical industry to evolve past patient memberships.

Here are some highlights:

A membership is not a prerequisite for care, and it doesn’t replace insurance. That begs the question, is there really a need for them at all? The answer, in short, is no. Air medical services are provided in life-threatening situations when time is of the essence, and there is no time to “schedule” or “wait” for a transport.

We encourage all air medical services that offer membership programs to end them, refund Medicare enrollees who never needed them, and adopt more effective practices.

Over the last four years, Air Methods has deployed multiple strategies to make billing as transparent and simple as possible for our patients. Our guiding principle is to approach any billing concerns according to what is best for them. To accomplish that, we have aggressively pursued in-network agreements with any willing payer who will come to the table and negotiate with us. This has resulted in over 50 percent of our privately insured patients being covered by in-network agreements – up from just 5 percent only four years ago – with partners like Anthem, Humana, and most states’ Blue Cross Blue Shield plans.

Read the full article here.

This week, we celebrate the one-year anniversary of JaeLynn Williams taking the position of CEO at Air Methods. Given her deep passion for customer and patient care and her strong focus on accelerating growth, JaeLynn has delivered on achieving Air Methods ambitious goals through strong leadership and collaboration.  

Since stepping into her role, she has spearheaded a variety of initiatives aimed at revamping and improving the industry. A key objective has been bringing Air Methods services in-network with insurance plans throughout the U.S. As Air Methods’ EVP of Sales and Marketing prior to taking on the CEO role, JaeLynn was responsible for creating value for customers while driving growth in the two healthcare markets the company serves: pre-hospital/EMS and hospital systems.

The pandemic has affected all of us at Air Methods – as it has everywhere – on a very visceral and personal level. JaeLynn assumed leadership of Air Methods during this time and has found this global challenge has shaped the direction of the company and her decision-making in countless ways. Leading has been complex, but it helps to be inspired by the entire Air Methods team and have the support of a superb executive leadership team.

It is JaeLynn’s passion for the Air Methods mission that makes her such an outstanding leader and we look forward to another year of outstanding results for the company.

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.

On Thursday, December 10, 2020, Chris Myers, Air Methods EVP of reimbursement and strategic initiatives, testified before NCOIL in support of the Model Act Regarding Air Ambulance Patient Protections, which seeks to regulate air medical memberships as insurance products. The following is the complete text of that testimony.

Chair Hunter and Vice Chair Ferguson, thank you for the time today to address you and the committee members on this very important topic. I am joining you today representing Air Methods Corporation in support of the Model Act Regarding Air Ambulance Patient Protections (introduced by Delegate Steve Westfall of West Virginia and Representative Tom Oliverson of Texas).

Air Methods serves 49 states with over 400 helicopters and fixed wing aircraft representing over 65,000 time-sensitive transports a year. When called by an independent physician or first responder we have an asset deployed with our highly trained clinicians and pilots within less than 15 minutes. The most common conditions that we treat are trauma, cardiac, stroke, and respiratory stress where minutes matter to the outcome of a patient. During these unique times we have transported over 4,000 COVID patients, as well. As rural hospitals continue to close, we are the last line of defense to get patients to the Level I trauma center to best serve their needs.

Over the last four years, Air Methods has deployed multiple strategies to make the patient billing experience as transparent and simple as possible. Our guiding principle is to approach any billing concerns according to what is best for the patient. To that end, we have aggressively pursued in network agreements with any willing payer which has resulted in us having 50% of our privately insured patients covered by in network agreements with great partners like Anthem, Humana, and most states Blues plans. This is up from only 5% just four years ago. United, Aetna, and Cigna remain the final opportunities for us to be 100% in-network. Being in-network is the best way to remove the financial burden from patients and ease the reimbursement process. Additionally, we have deployed patient advocates that are individually assigned to patients with an out of network payer and a robust financial assistance policy so that the average out-of-pocket for all our patients is $167 and getting lower. We do NOT balance bill patients and only send patients a bill if they have never provided us a payer of record or communicated with us to qualify them for financial assistance, including 100% relief.

Air Methods supports Delegate Westfall and Representative Oliverson’s model act because it aligns with our patient centric approach and protects patients from unscrupulous insurance and insurance-like products and related practices. Many membership sales tactics feel like being both arsonist and fi re fighter, where consumers are scared into thinking they will have a big bill and therefore need to buy a membership to avoid this imminent peril, from the same company that is transporting them. This is the opposite of providers working to truly take the patient out of the middle. The overwhelming majority of air ambulance transports are for Medicare and Medicaid beneficiaries who have a defined fee schedule and copay. Medicare patients are disproportionately marketed to with tactics like special “senior pricing.” The prevalence of these products being sold to seniors is cause for question about whether regulation is needed. If only 25% of the three million AirMedCare Network memberships are sold to seniors, this would make it the second largest Medicare supplemental product sold in the U.S.

The lack of regulation of these membership programs today has created financial opportunists like Helimedic, which launched a web-site selling memberships but has no verified operations. It claims to cover the entire country in only minutes with only a few helicopters based out of Texas and California. Additionally, when you attempt to call the posted contact number it connects to no one. Yet, they are still trying to sell air ambulance memberships at $500 for an individual or $1,500 for a “family,” even garnering local news coverage.

From an actual utilization perspective, there are approximately 360,000 air medical trans-ports a year which represents 0.1% of the U.S. population. Given the extremely low utilization of all air medical services, one wonders why there are millions of annual memberships sold each year. Additionally, 80% of our transports are covered by a set fee schedule. Given this dynamic, Air Methods has chosen to apply resources to mitigate any patient out-of-pocket expense to the patients that actually need it versus those that do not and will likely never need it.

I will leave it to others smarter than I am to conclude whether you believe memberships are insurance products or not, but a simple definition from Black’s Law Dictionary states, “Insurance is a contract by which one party (the insurer) undertakes to indemnify another party (the insured) against risk of loss, dam-age, or liability arising from the occurrence of some specified contingency.” And borrowing from the Guardian Flight v. Godfread opinion, “if a bird looks like a duck, swims like a duck, and quacks like a duck, a reasonable person can only conclude that it is indeed a duck.” Montana, New York, Connecticut, and Wyoming have all decided to regulate memberships as insurance, and Florida requires licensure and regulatory oversight as an insurance company to sell to Florida consumers. Patients and consumers should have full transparency and under-standing of the product they are purchasing and not have their care compromised or face unexpected bills.

The arsonist and firefighter sales tactic utilized to sell air ambulance memberships puts undue pressure on patients and doesn’t fully disclose the financial terms of the insurance product they are purchasing, or the fact that it isn’t needed. Patients have sued membership providers for balance billing them when the patient received a legal settlement, and the membership provider tried to collect those funds. Uninsured patients may not necessarily understand that, per the contract terms of some providers, they can be billed the Medicare allowable rate which isn’t covering their out-of-pocket costs in full. The one point that contract membership terms make abundantly clear, is that they only cover the patient in the scenario where that specific provider transports them – this creates unnecessary and dangerous pressure on the patient to delay their care and wait for their “free” air ambulance transport. This is a risk that patients who need time-sensitive air ambulance transport cannot afford to take. At Air Methods, we have chosen a decidedly different path to memberships. You do not have to pay us a membership fee to do what is best for the patient. It is a part of the service we provide.

Thank you, Chair Hunter, Vice Chair Ferguson, and committee members, for the time you have provided me today.

Since March 2019, Air Methods has worked to eliminate air medical memberships from the industry. We will continue this fight because it is the right thing for our patients and the communities we serve. NO MEMBERSHIP REQUIRED.

What is NCOIL?

NCOIL is the National Council of Insur-ance Legislators. From the NCOIL web-site:
NCOIL is a legislative organization com-prised principally of legislators serving on state insurance and fi nancial institutions committees around the nation. NCOIL writes Model Laws in insurance, works to both preserve the state jurisdiction over insurance as established by the McCar-ran-Ferguson Act seventy-four years ago and to serve as an educational forum for public policy makers and interested parties.

NCOIL works to:
• Educate state legislators on current and perennial insurance issues
• Help state legislators from different states interface effectively with each other
• Improve the quality of insurance regulation
• Assert the prerogative of legislators in making state policy when it comes to insurance
• Speak out on Congressional initiatives that attempt to encroach upon state primacy in overseeing insurance

NCOIL is an adamant, vocal opponent of any Congressional initiative that would de-prive consumers of key state protections, preempt state laws that respond to unique insurance markets, threaten critical state premium tax revenue, and, in many cases, lead to cherry picking and fraud.

We’re happy to announce that we have entered an in-network agreement with HealthPartners, a consumer-governed, nonprofit healthcare organization based in Bloomington, Minnesota. The agreement enables Air Methods to provide HealthPartners plan members – totaling 1.8 million people across Minnesota, Wisconsin, Iowa, Illinois, North Dakota, and South Dakota – with critical air medical services at discounted in-network rates. The agreement includes commercial insurance, state public programs (SPP) and Medicare Cost.

“As many states in the Midwest see spikes in COVID-19 cases, air medical services are more important than ever,” according to Chris Myers, our executive vice president of reimbursement. “Air ambulances are crucial for interfacility transports during hospital surges and are also key in quickly reaching patients in rural areas. We are proud to enter this agreement with HealthPartners, which will ensure those who need air medical transport will receive it at affordable rates. We encourage all health insurance companies to negotiate similar agreements with Air Methods.”

Air Methods is now in-network with more than 100 health plans in more than 40 states. The latest agreement with HealthPartners continues Air Methods’ focus on expanding its in-network partnerships to 100 percent of plans in the country.

Expanding high-quality care access to rural regions

As hospitals across the country continue to be shuttered, access to care is a growing necessity for many, especially those in rural areas. However, even in highly populated states, nearby emergency and specialty care are not always available.

Today, more than one-quarter of the American population, 85 million residents, can only access a Level I or II trauma center within an hour if they are flown by air medical transportation. Nationally, 15 rural hospitals have closed in the U.S. this year. According to the National Rural Health Association, rural residents have greater transportation difficulties reaching health care providers, often traveling great distances to reach a doctor or hospital.

Air Methods eliminates those geographic obstacles while providing life-saving interventions during missions, such as clot-busting medications that must be given shortly after a major stroke to significantly improve outcomes and trauma care after an accident. Air ambulances are considered “flying ICUs” and the clinical teams flying on these missions have the highest first-attempt success rates in the nation among their peers at performing prehospital intubations, which is an emergency medical procedure to open a patient’s airway when breathing is obstructed. Developed exclusively by Air Methods’ clinicians, this emergency process was recently published in the leading textbook for emergency medicine continuing education, Prehospital Trauma Life Support (PHTLS) (9th Edition).

Yesterday, the New York Times published an article about a COVID-19 patient in Pennsylvania who was transported by Air Methods. After the transport, the patient’s health insurance company, Independence Blue Cross, denied coverage for the COVID-related transport and medical care. The article incorrectly identified Conemaugh Medstar as the Air Methods partner that transported the patient, when in fact it was an air medical aircraft out of New Jersey.

We worked closely with the patient and her daughter throughout the claims process and provided the guidance that ultimately led to the claim being resolved. The patient’s daughter communicated with Air Methods and Independence while her mother recovered, but became concerned when Independence said they would not provide her with any information on the status of her mother’s claim. During that same time, Air Methods committed to working with both the patient and their insurance to get the claim resolved. We have set up a robust patient advocacy program to address such issues with insurers, as they happen often.

COVID-19 has hit healthcare providers particularly hard, including Air Methods. While many health insurers are reporting record profits during the pandemic, most health providers have been relying on CARES Act funds to make it through these difficult times, while continuing to serve every patient who needs us. As a recipient of CARES Act funding, Air Methods does not balance bill any COVID-19 patient and made that commitment even prior to receiving those funds. 

It is also important to note that, despite our efforts, Independence Blue Cross has refused to go in-network with Air Methods, or any air medical service provider not affiliated with one of its partner hospitals. The company is an outlier in our negotiations with Blue Cross and Blue Shield plans, as we have had success going in-network with many of them throughout the U.S., including plans in Pennsylvania, Maryland, New York, and Virginia.

Complications like these could be avoided if Independence Blue Cross – along with the big three national health insurance companies: Aetna, CIGNA, and UnitedHealth – would negotiate in good faith with Air Methods and include us in their network of providers. But until they do so, insurance will continue to force their customers to go through their arduous appeals process. 

The New York Times reporter reached out to Air Methods with a series of questions that we responded to in detail. Unfortunately, most of the information we sent her was not included in the article.

In the interest of transparency, we have decided to share the responses that we provided the reporter in full. We think this is important because it shows the level of detail that we shared and demonstrates Air Methods’ dedication to working directly with patients to resolve all billing issues.

The questions the reporter sent to Air Methods, and the responses we provided to her, are below:

1. Approximately how many coronavirus patients has Air Methods transported during the coronavirus pandemic? How many patients does Air Methods fly in a typical year?

Air Methods flies about 70,000 patients every year. Since the pandemic began, we have flown 3,300 suspected coronavirus patients.

2. Has Air Methods instituted any new billing policies related to coronavirus?

We publicly stated months ago, even before the CARES Act passed, that we created a special process for handling all COVID-19 patients and that we would not balance bill COVID-19 patients. Air Methods has remained committed to that practice.

3. How does Air Methods set the charges for inter-facility transport?

The cost of this around-the-clock readiness averages nearly $3 million per year for each air base. Further, approximately 85 percent of costs are fixed costs associated with operating an air base, giving companies little leeway in reducing costs on their own. And then, the payors set reimbursement rates for our services. We have no control over the number they settle on. We must appeal and/or negotiate the claim with the payor to receive a fair reimbursement. However, reimbursement for air medical services has not kept up with costs. Medicare, which covers air medical services in emergency cases only, established the current air medical service payment rates in 2002 based on an estimated 1998 cost pool. Today, the average Medicare per-transport reimbursement covers approximately half of the cost per transport, according to a cost study prepared for the Association of Air Medical Services (AAMS). Medicaid, on average, covers barely 30 percent. With the government insurance programs, Medicaid and Medicare significantly underpaying for transports, and uninsured patients paying very little (or nothing at all) for our services, any uncollected costs from those flights must be picked up by commercial payors.

4. Air Methods currently faces, by my count, six class action lawsuits in different states. Can you provide any comment on those lawsuits, which generally allege expensive fees and aggressive debt collection tactics?

While we cannot speak to the specifics of ongoing litigation, most of these lawsuits related to transports and associated billing are between six tp eight-years-old. Since that time, Air Methods has changed the way we do business, especially as it relates to the aftercare of our patients. For the past three years-plus, Air Methods has made it a priority to partner with insurers all over the country to develop in-network agreements that eliminate the possibility of a patient ever receiving a balance bill. We have seen a good deal of success and are now in-network with more than 50 insurers throughout the United States. We have also implemented a Patient Advocacy program through which we work directly with our patients’ insurance companies to coordinate reimbursements. This keeps patients out of the middle of the billing process, which can be confusing and stressful, especially while recovering from a serious medical issue. The average patient out-of-pocket cost for our patients is $167, which includes co-pays/deductibles. While Air Methods is in-network with nearly 50 percent of our commercially insured transports, it is our goal to be in-network with 100 percent. We have contracted with almost every payor in the markets we serve but have been unable to get Aetna, Cigna, or United to contract with us despite offering them lower rates which means their members remain stuck in the middle. In an effort to remove the patient, we are proactively contacting and signing agreements directly with employers who have health insurance coverage with Aetna, Cigna, or United to ensure that their employees have coverage for emergency air medical services. 

5. Approximately how often does Air Methods pursue debt in court? Does Air Methods use garnishments and liens to collect debt? I came across one case where Air Methods pursued a $53k garnishment from a patient’s bank account and wanted to know whether that type of debt collection is common or uncommon for the company.

We do not use liens or garnishments to collect debt. There was, unfortunately, a time when Air Methods pursued debt through garnishments and liens. But that approach has been eliminated from Air Methods’ processes when pursuing reimbursement from health insurance companies. It is clearly an ineffective way to settle billing issues and we have no desire to put our patients through that stress after we have transported and treated them.

There are only two reasons we will refer a patient’s account to a third party billing agency. If a health insurance company directly provides the payment to the patient rather than us, the medical provider, and the patient doesn’t use such payment to pay for medical services rendered. Unfortunately, many times insurers tell their customers to hold onto the payment. The only other instance that would cause us to send a patient to a third party billing agency is if, after a number of attempts and at least 120 days, the patient is non-responsive to our calls/communications asking for insurance status after the flight, which allows us to assist them with their health insurance company to get their bill resolved. We assist patients by assigning a Patient Advocate to every individual we have transported whose insurance will not pay their bill. Patient Advocates work with patients after they have been transported to help guide them through the billing process and advocate on their behalf when insurance companies that are not in-network deny a claim. 

6. In this story, I am looking at a $52,511 bill received by a patient who was inter-facility transported due to her coronavirus worsening. The patient was transported by Conemaugh Medstar, one of Air Methods’ subsidiaries. I attached that bill to a previous email for your review. Would you like to provide any comment on this case in particular, how the charges were set, and how the decision to bill [the patient] was made?

To be clear: We never sent a bill to [the patient], and our Patient Advocacy team assisted her through the entire insurance reimbursement process, which can be very confusing for our patients and their families. The outreach you referenced was the second communication from us to [the patient and was an update on where things stood with [the patient]’s insurance company, Independence Blue Cross Pennsylvania.

We have worked closely with [the patient]’s daughter since [the patient] is still in the hospital. She was incredibly helpful as her mother recovered and she did all she could to keep us updated on where things stood with their health insurance company. Independence Blue Cross initially provided a check that covered a small portion of the transport costs. Then, on June 24, [the patient]’s daughter reached out to tell us Independence was “not cooperating” with her family and that the reps from Independence would no longer discuss [the patient]’s case with her daughter nor with [the patient]’s husband either, who is the policy holder.

We told [the patient]’s daughter that we would assist the family with the underpayment appeal with Independence Blue Cross. We explained we would work with her and her family every step of the way, as [the patient continued to recover in the hospital. However, that same day, [the patient]’s daughter responded and told us Independence had informed her the initial reimbursement check was voided, and that the Independence rep would not share any additional information with her. We then reached out to Independence and a rep informed us that the claim had been denied because [the patient]’s plan “does not provide coverage for this service.”

After we learned that Independence had denied the claim, we reached back out to [the patient]’s daughter informing her that we would work with her on the appeal regarding this unfortunate denial of service. About a week later, [the patient]’s daughter told us she had spoken to an Independence rep, who told her the claim had been reevaluated and that a check would be sent to cover the entire cost of the emergency air medical transport provided by Air Methods. On August 11, we received an email from [the patient]’s daughter stating she had received a check from Independence for the full reimbursement, and she planned to mail it to us. 

The above process illustrates that we do not bill patients whose claims have been denied by their health insurance plans. It is truly unconscionable that, in this case, [the patient, a COVID-19 patient, has her insurance company issue payment for only a small amount, then the insurance company pulls it back and voids the payment by denying the services, then it reevaluates the care and, finally, pays the for the entire cost of care that Air Methods provided. This all could have been avoided if they would have done their due diligence in understanding that the patient had COVID-19 and/or they would go in network with air medical services. For our part, our Patient Advocate teams work closely with our patients to ensure they have guidance through the reimbursement process. We do this so that they are not alone in figuring out the steps that need to be taken. [the patient]’s family was incredibly cooperative throughout the entire process, and we are grateful [the patients recovering and that we were able to assist her in resolving this claim.

7. Has Air Methods or any of its subsidiaries received any funding from the Provider Relief Fund in the CARES Act? If so, how much?

Air Methods has received funding from the Provider Relief Fund in the CARES Act.

Follow-up question from reporter: I’m a little confused though by the statement that you never sent [the patient] a bill. The document dated June 1 has a box that says “amount due” and offers various methods of payment, a website to pay at, etc. Why shouldn’t that be considered a bill? 

The response is a bit long, but that is because this process becomes complicated when payors deny a claim for Air Methods’ emergency air medical transports – even when the transport is for a patient with complications due to COVID-19. Air Methods’ Patient Advocacy program is in place just for these situations – we are committed to walking our patients through this process and making sure they understand the steps being taken to resolve the claim so that they can focus on their recovery.

There are several reasons why the letter referenced in the story isn’t a bill. If the letter was the only correspondence the patient received, without any further guidance or explanation, we certainly acknowledge that it would be confusing. However, it was only one communication among many, over many months.

The letter referenced in the story was actually the second one Air Methods sent [the patient, and both of them explained that we were asking for her assistance in resolving the claim with her insurance company. We had already been in communication with [the patient]’s daughter where she advised us that they were expecting a reimbursement check from [the patient]’s insurance company, Independence Blue Cross Pennsylvania, prior to the letter dated June 1 was sent with that context in mind as [the patient]’s daughter planned to send that check to us as we worked with Independence to secure the remainder of the reimbursement. However, Independence then abruptly voided the check and told [the patient]’s daughter they would not share any additional information with her about the claim. [the patient]’s daughter then reached out to us and said Independence was “not cooperating” with her family and that the reps would no longer discuss [the patient]’s case with her or [the patient]’s husband, who is the policy holder.

This was all occurring as [the patient] was still recovering in the hospital. The letter we sent dated June 1 was sent after one of our patient advocates had already established communication with [the patient]’s daughter and explained how we would help her through the billing process with Independence. However, after the June 1 letter was sent, we then spoke with [the patient]’s husband on June 3 and he advised he was calling Independence to get the status of the reimbursement. Later that same day, [the patient]’s daughter called us and let us know she had spoken with the payor and had been told the claim was still in process. All of this background is to say, we are committed to communicating with our patients throughout the post-transport insurance process, and our goal is to ensure they have a clear understanding of that process. We spoke with [the patient]’s daughter several times throughout the summer. At no time did we give her the impression, nor do we believe she had the impression that we were pursuing payment from [the patient]). We were seeking payment from Independence Blue Cross Pennsylvania. If it were up to us [the patient] and her family would never have had to go through this process, which is established by the Independence Blue Cross Pennsylvania. The fact that she did is very unfortunate and Air Methods and our Patient Advocates do all we can to make it as easy as possible by working with the insurance company directly so patients like [the patient] and her family don’t have to.

Without the context of the many productive conversations we had with the [the patient]’s family, we acknowledge this one piece of communication (the letter) could be misconstrued as a bill. But it is not a bill and we believe [the patient]’s family fully understood that because we were in regular communication with them. What’s more, the goal of Air Methods is to go in-network with 100 percent of the health insurers in the U.S. to avoid these long, drawn-out situations that ultimately result in Air Methods receiving payment from the health insurance company anyway. It raises an obvious question: Why go through this long, drawn-out process in the first place? If payers – like Independence Blue Cross Pennsylvania, as well as the large health insurance companies like Aetna, Cigna, and UnitedHealthcare – would simply come to the table and negotiate with us, patients like [the patient] would not have to go through what she went through. For now, because this is the process dictated wholly by the health insurance companies that control whether these transports are covered, we do all we can to guide our patients through it. Obviously it’s a very complex situation, and one letter among months of communication certainly cannot tell the full story in any meaningful way.

For the past three years, Air Methods has been focused on securing in-network partnerships with health insurance companies so that our patients receive a discounted rate for our services.

Air Methods is now in-network with more than 50 commercial health plans across the U.S. Over 80% percent of the population is covered for Air Methods’ high-quality care either through commercial insurance or through Medicare or Medicaid so they will not receive a balance bill for services. We are committed to being 100% in-network and continue securing new partnerships as we work toward that goal.

As Air Methods continues to secure additional in-network agreements, its Patient Advocacy program also supports patients with insurance bills when their air medical care and transportation is an out-of-network benefit. The Patient Advocacy program team works on the patients’ behalf, especially as related to supporting patients with billing questions and insurance appeals.

Earlier this year, Air Methods SVP of Reimbursement, Chris Myers, wrote an article on the importance of health insurance companies going in-network with air medical companies for Managed Healthcare Executive. You can read that article here to learn more here.

On September 18, 2020, Florida Gov. Ron DeSantis signed HB 747: Coverage for Air Ambulance Services into law. Air Methods has released the following statement on the legislation:

Two years ago, when Gov. Ron DeSantis was on the campaign trail, he praised “patient-centered, market-based insurance.” But that notion suffered a severe setback for patients when the Florida State Legislature passed and, on September 18, Governor DeSantis signed, HB 747.

This bill – signed into law not only during the COVID-19 pandemic, but also in the middle of hurricane season – incentivizes health insurance companies in Florida to exit in-network agreements with air medical services, severely limiting the transport and prehospital care air ambulances provide to critically injured or ill patients. In short, it puts Floridians at risk while making insurance companies more profitable.

Several major U.S. health insurers recently reported massive second-quarter earnings, more than double what they were in 2019. These enormous gains are in stark contrast to the financial hit many hospitals have taken during the pandemic. Air medical services partner with these facilities to transport patients to appropriate sites of care in a timely manner, thus limiting the cost of care hospitals incur. HB 747 puts this lifeline at risk in many communities.

This legislation was pushed through unilaterally by health insurers with no public health data to support it. Their bill treats air medical services as an excessive element of Florida’s healthcare system. That is an incredibly dangerous stance, and its effect will be to compromise Floridians’ access to care in favor of health insurers’ balance sheets.

Rather than pushing for health insurance companies to go in-network with air medical services, the state government is essentially setting rates based on confidential reimbursement agreements. Health insurers now have the greenlight to put their profits ahead of the interests of our Florida patients. It is Big Government at its worst and price-setting has no place in a patient-centric health system.

HB 747 allows Florida insurers to set the reimbursement bar so low that they now have no reason to negotiate reasonable rates with providers or stay in existing in-network agreements that currently cover patients. It leaves Florida vulnerable to losing access to emergency air medical services, because there is no guarantee that providers can survive on what health insurers will now choose to pay. Moreover, HB 747 was not needed to protect patients. Health insurers could have protected patients years ago by negotiating in-network agreements with Florida’s emergency air medical providers, but many choose not to. As a result, the very bills that HB 747 claims to protect patients from are a consequence of the health insurers refusing to adequately cover emergency care.

With air medical bases throughout the state, Air Methods has worked hard to show the benefits of going in-network and has done just that with Florida Blue. We have seen our partnership with Florida Blue directly benefit our patients by simplifying the billing process for them and lowering their out-of-pocket costs. Now we need insurance companies like Aetna, Cigna, and UnitedHealthcare to do the same thing. Yet HB 747 all but guarantees these three companies will walk away from any negotiations and could jeopardize our other in-network agreements.

Since the pandemic, Air Methods has transported more than 120 suspected COVID patients in Florida. Our dedicated crews will continue to work hard to treat and transport any Floridian who requires our care. Meanwhile, our Patient Advocacy program has continued to assist any of our patients put in the middle of the billing process by their health insurer and has successfully lowered our patients’ average out of pocket costs to only $167. Unfortunately, HB 747 provides insurance companies a government-mandated excuse to continue to keep patients out-of-network for air medical services.  

We are asking the federal courts to overturn this law and protect Florida citizens’ access to much-needed emergency air medical care.