Many Could Face Sky-High Surprise Bills from Air Ambulance Flights

Ground ambulance rides also put majority of patients with private insurance at risk for unexpected out-of-network bills, study finds.

5:00 AM

Author | Kara Gavin

Air ambulance bills

Editor's note: Information on the COVID-19 crisis is constantly changing. For the latest numbers and updates, keep checking the CDC's website. For the most up-to-date information from Michigan Medicine, visit the hospital's Coronavirus (COVID-19) webpage

Interested in a COVID-19 clinical trial? Health research is critical to ending the COVID-19 pandemic. Our researchers are hard at work to find vaccines and other ways to potentially prevent and treat the disease and need your help. Sign up to be considered for a clinical trial at Michigan Medicine.

When an emergency dispatcher calls for a helicopter or plane to fly a critically ill patient to a hospital, they don't have time to check whether they take the patient's insurance.

Every minute matters for someone badly injured in a car crash, suffering a heart attack or stroke, or needing critical care for serious birth defects, organ transplants or COVID-19.

But after those patients land, 72% of them could face a potential "surprise bill" because their ambulance provider isn't "in network" with their insurance, a new study of people with private insurance finds. When ambulances aren't in-network, they can charge whatever they see fit, and insurance isn't always obligated to pay those charges in full.

So patients could be on the hook for "balance bills" up to $20,000 per ride, the study by a University of Michigan team in the May issue of Health Affairs shows.

Even if the dispatcher chooses a ground ambulance to drive a patient with a medical emergency to a hospital, the study finds that 79% of patients could get a surprise bill, with an average total around $550.

If you truly need an ambulance, concerns about cost should not get in the way.
Karan Chhabra, M.D., M.Sc.

And even for patients who take ambulances for non-emergency reasons, arranged in advance with time enough to check insurance coverage, over half of patients could face a surprise bill for the out-of-network portion of the cost. On average, the study shows that bill could top $400.

The authors note that, while air ambulance charges are high, ground ambulance rides are far more common. As a result, out-of-network ground ambulance bills amount to a larger problem overall:  $129 million per year, versus $91 million for out-of-network air ambulances. But annual out-of-network air ambulance bills are catching up quickly. 

Shedding light on potential surprises

People with emergency medical needs should never let worries about surprise bills keep them from riding in any ambulance called by a 911 operator, physician or first responder, say the researchers behind the new study.

MORE FROM THE LAB: Subscribe to our weekly newsletter

"Anecdotally, we hear of more people taking Uber or a Lyft, or having someone drive them, to the emergency room to avoid an ambulance bill," says Karan Chhabra, M.D., M.Sc., a National Clinician Scholar at the U-M Institute for Healthcare Policy and Innovation and surgery resident at Brigham and Women's Hospital in Boston.

"But if you truly need an ambulance, concerns about cost should not get in the way. Arriving by ambulance, with a trained crew that can assess your needs, begin treatment and radio ahead to the hospital, means you're more likely to be triaged and treated appropriately when you arrive."

The new study can't tell how many patients actually got a surprise bill – just how many could have. It's based on five years' worth of insurance claims from nearly 1.5 million ambulance transports, including nearly 26,000 by air in the 41 states with more than 50 flights. The study is based on data from patients with commercial insurance offered by one large national company.

Policy implications

Chhabra and his colleagues hope that their work will shine new light on the size and frequency of potential surprise bills from a type of care that federal and state policy fixes often overlook.

Lawmakers have been looking closely at "surprise" out-of-network bills in hospital care, but those occur in only 10 to 20% of cases. The new study shows that the risk of out-of-network bills in ambulance-based care is many times higher.

SEE ALSO: 1 in 5 Operations May Lead to "Surprise" Bills – Even When In-Network, Study Finds

The study also challenges claims by the growing for-profit air ambulance industry that increased competition among service providers would hold down cost growth. From 2013 to 2017, the size of a potential surprise bill for air ambulance rides rose 15%, after adjustment for inflation, driven by an increase in the amounts air ambulance companies charged insurance companies for transport of patients.

Air ambulance companies have fought surprise billing legislation in court, using the federal Airline Deregulation Act passed in 1978, which was actually designed to increase competition in commercial airline travel.

Air ambulance companies operating on a for-profit basis have proliferated across the country since the deregulation of the air ambulance industry in 2008. The air ambulance service for U-M's academic medical center, Michigan Medicine's Survival Flight, is a nonprofit service that was established in 1984 and does not balance-bill patients.

Future directions

Because of previous research and media reports about surprise bills, policymakers are already assessing potential approaches for reducing the risk to patients. Medicare and Medicaid already bars healthcare providers from sending "balance bills" to their members.

SEE ALSO: Even with Insurance, Hospital Patients May Pay Over $1,000 for Stay

But patients with commercial insurance — who far outnumber those in Medicare and Medicaid — can still legally be balance billed for out-of-network care in many states. In fact, most patients with commercial insurance cannot be protected by state legislation because their plans can only be regulated federally.

Lawmakers in both chambers of Congress have proposed legislation to end surprise billing, and have even tried to include these fixes in COVID-19 relief packages. Chhabra and the study team believe that protections for patients who require air and ground ambulance care should be incorporated into these federal efforts.

In addition to Chhabra, the study's authors are senior author Andrew Ryan, Ph.D., a professor at the U-M School of Public Health who directs the Center for Evaluating Health Reform; SPH student Keegan McGuire, resident Kyle Sheetz, M.D. M.Sc., and assistant professor John W. Scott, M.D., M.P.H., of the U-M Department of Surgery, and Ushapoorna Nuliyalu, M.P.H.. Chhabra.Scott and Ryan are also members of IHPI, which funded the work.

Like Podcasts? Add the Michigan Medicine News Break to your Alexa-enabled device or subscribe for updates on iTunesGoogle Play and Stitcher.


More Articles About: Industry DX Health Care Delivery, Policy and Economics Emergency & Trauma Care
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]

734-764-2220

Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Subscribe
Featured News & Stories man legs hospital socks bed
Health Lab
An emergency in U.S. emergency care
Full emergency rooms, made worse by hospital staffing shortages, have led more patients to leave without being seen or to wait for hours in the emergency department for a hospital bed
brain with bandages on it pink and red
Health Lab
The U.S. is failing to care for traumatic brain injury survivors, experts say
Patients with traumatic brain injury in the United States are at the mercy of an oversimplified and inadequate classification and health care system. Experts are calling for comprehensive investment and systemic overhaul for TBI care.
side by side of covid simulated tweets
Health Lab
From the Heart: Study Shows Impact of Social Media Appeals from COVID-19 Frontliners
Emergency physicians sharing personal messages has across-the-board impact, randomized simulation finds.
hospital beds in different colors
Health Lab
What Can Hospitals Do to Prepare for COVID-19 Cases?
Hospital preparedness for COVID-19 cases caused by coronavirus has to happen now, including preparation for bed capacity increases and use of scarce resources.
Health Lab
Emergency Medicine: Department-Based Intensive Care Unit Improves Patient Survival Rates
Michigan Medicine study shows emergency medicine patient mortality rates improve after implementation of innovative emergency department-based intensive care unit.
Health Lab
Reducing Overtesting in the Emergency Department Could Save Millions
A new study finds there’s excessive imaging testing being performed in the emergency department. A reduction could save millions in health care costs.