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.