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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 indemnity products.
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 insuranceNCOIL 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 PresentationAMCN Brochure with Terms & Conditions
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.
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.
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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.
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 all see older adults around the country make their mark every day as volunteers, employees, employers, parents, grandparents, mentors, and advocates. They offer their time, talents, and experience to the benefit of our communities.
May is Older Americans Month (OAM) and, as we come to the end of the month, we wanted to make sure we recognized these invaluable members of our society. During this annual celebration, led by the Administration for Community Living (ACL), OAM offers resources to help older Americans stay healthy and independent.
At Air Methods, we are proud to do our part to ensure the health, safety, and independence of older Americans by providing air medical transport during emergencies ranging from accidents on the road to health concerns like heart attacks and strokes. When people from this older demographic are in need, we work hard to provide them with the best care available, and quickly get them to a facility where doctors and nurses can continue that care.
We are also dedicated to making access to air medical services as simple as possible. That is why, last year, we implemented our No Membership Required program.
For many years, air medical services have sold memberships as a way for patients to access emergency services in the most critical situations. However, these memberships are not right for patients – particularly for older patients. If someone ever needs air medical care, they receive it with or without a membership. They are in critical condition and the last thing anyone should worry about is of which air medical service a patient is a member.
In addition, air medical services are already covered for Medicare and Medicaid beneficiaries, so no membership is necessary. As a commitment to these patients, Air Methods has been in the process of refunding any membership fees paid by those who have Medicare or Medicaid.
According to AARP, “the number of people 65 and older in the United States is expected to increase to 55 million in 2020; to some 70 million by 2030, and to 88.5 million – or 20 percent of the population – in 2050. (Put yet another way, between 2006 and 2030, the U.S. population of adults aged 65+ will nearly double from 37 million to 71.5 million people).”
It is important that this growing population of older Americans know what care they are entitled to, and that they understand memberships are completely unnecessary should they require air medical services.
(GREENWOOD VILLAGE, Colorado, November 18, 2019) – Air Methods, the leading air medical service, announces that it has launched nationwide the “No Membership Required” initiative to allow patients to focus on recovery and not have to navigate the insurance and billing process alone. With this initiative, and based on the success of Air Methods’ Patient Advocacy program, its in-network growth strategy, and a Community Partnership Program, Air Methods discontinued selling its Air Methods Advantage membership program in April 2019.
Air Methods announced that it is refunding any membership fees paid by Medicare beneficiaries who were members when the program ended in April.
Medicare Part B beneficiaries are already covered for air medical services without a membership. Air Methods and its Patient Advocacy team works with beneficiaries to make sure their copays and deductibles are affordable. In 2018, the average out-of-pocket cost for Medicare patients transported by Air Methods was $280, including copays and deductibles. Air Methods will refund any membership fees paid by those members who were of Medicare age when the program ended in April 2019. The company will mail checks to those members within the next 60 days.
Because all Medicare Part B beneficiaries are covered for air medical services regardless of the company that transports them, Air Methods is challenging other companies in the industry to do the same and refund membership payments made by Medicare beneficiaries.
Air medical services are provided in life-threatening situations where time is of the essence, and asking patients to remember which company they have a membership with to avoid a balance bill adds an unnecessary layer of stress to an already intense situation.
Air Methods’ mission is to deliver safe and reliable critical care in the air 24/7/365, treat every patient with care, and help them navigate the often confusing insurance process. Air Methods will honor all existing memberships, but once a patient’s membership expires, it will not be renewed.
Increasing in-network agreements Memberships were created and sold in the past on the premise that it would help patients avoid unexpected out-of-pocket expenses related to the potential of needing air medical services. Today, Air Methods is taking a new approach to achieve this same goal: it is going in-network with a growing number of insurance providers to avoid balance bills. In-network coverage offers consumers a discounted, out-of-pocket payment for qualified services, which varies depending on their plan’s benefits. Staying in-network for healthcare services can help consumers avoid unexpected spending as well as balance billing, which is the practice of billing a patient for the difference between the plan’s reimbursement and the medical charges.
Air Methods now has 47 in-network agreements across the United States. Today, approximately 75 percent of Air Methods’ patients are covered for its services either through commercial insurance or through Medicare Part B or Medicaid, so patients will not receive a balance bill for services. Patients of these private insurance plans do not require a membership, and will only be responsible for their copayments and deductibles, if applicable by their plan.
Air Methods will work with all patients to ensure a financially feasible outcome is reached so that no patient has to worry about their bill while recovering from an emergency.
“Air Methods understands how complicated and nuanced the healthcare system can be and how stressful balance billing situations are for patients and families when they need to focus on recovery,” said Steve Gorman, Air Methods’ CEO. “For that reason, we are committed to further helping patients by no longer requiring memberships. By focusing instead on in-network agreements with any and all health insurance carriers who will partner with us, we are dedicated to reducing the burden of balance billing on the patients who need our life-saving services. With 85 million Americans living more than an hour from the nearest Level-1 or Level-2 trauma center if driven by ambulance, we are committed to taking every step possible to ensure their access to that care.”
Supporting patients with dedicated advocates Air Methods has a dedicated Patient Advocacy department, which provides patients with support and resources during the post-flight insurance billing process.
With a dedicated team of patient advocates on staff, Air Methods’ goal is to alleviate any stress on patients and their families, so that patients’ recovery is the focus. Patient advocates work with patients to help navigate the health insurance maze. Whether Air Methods is in-network or out-of-network with a patient’s health plan, patient advocates help with insurance claims, including navigating the appeals process if the insurance company initially denies or underpays the claim. When a patient works with the Patient Advocacy team, they normally only pay their deductible or co-insurance. On average, for all patients, regardless of payer, the out-of-pocket costs for Air Methods’ services is only a couple hundred dollars.
Partnering with local governmentsAir Methods actively partners with local government entities to ensure that local residents have access to life-saving air medical services without the worry of high out-of-pocket expenses. Through community partnerships, Air Methods works with local governments and assists with reviewing insurance claims received by county residents to ensure that they are aware of its Patient Advocacy services and financial assistance programs.
Air Methods encourages local governments to save the money they would otherwise spend on upfront nonrefundable membership fees, and instead create a charitable fund for patients to assist with out-of-pocket medical expenses, allowing for any remaining dollars in that fund to roll over to the next year or be spent on other priorities as the locality sees fit.
For more information about the No Membership Required campaign and details about the refund program, visit www.airmethods.com/nomembershiprequired.
About Air MethodsAir 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 FlandersDirector of Communications, Air Methods*protected email*
Matt PeraAmendola Communications for Air Methods(219) 628-0258*protected email*