Is affordable air ambulance transport a right?

Montana legislators have endorsed a bill to prevent financial ruin for patients who urgently need air ambulance transport


I've been commenting for some time now on the high cost of air medical transport being shouldered by patients and families. It makes sense that the bills are high – running an air ambulance is expensive. Reimbursement from insurance has been low, perhaps even lower proportionately compared to EMS ground transport. It's an upside down equation that has left patients holding the financial bag.

It would be great if we could choose our ground EMS or air ambulance provider, just as we do with our electronics, mortgage lender and the like. Then we could rely on market forces to give us the quality we want at a price point that works.

And therein lies the fatal flaw. During moments of crisis, we don't get to choose who we see. In sudden medical emergencies, who comes to take care of us is beyond our immediate control.

During moments of crisis, we don't get to choose who we see. (Photo/Pixabay)
During moments of crisis, we don't get to choose who we see. (Photo/Pixabay)

This situation plays out daily in rural Montana. Due to the scarcity of tertiary and specialty care centers across the state, and the risk incurred with super-long distance ground transport, patients have to be transported by air ambulances. For years, such patients have been saddled with tens of thousands of dollars of debt, incurred after the insurance companies paid their contribution toward the air ambulance bill. The chances of a patient going bankrupt from a medical emergency are quite high.

The Montana legislature has tried to broker discussions between air medical service providers and insurance companies for some time, trying to find a way to minimize government intrusion into the process. It appears that those efforts have fizzled.

Yesterday, Montana state representatives passed SB44. In doing so, they protected the interests of their citizens, trying to stave off financial ruin for those who urgently need this service.

If the bill becomes law, service agencies will not be able to bill the patient for the remainder of the cost that is not covered by health insurance. The bill also requires insurance companies to pay a portion of any bill regardless of whether the provider is within that insurance network. The legislation leaves the rest of the collection process between the insurance company and the air ambulance provider up to the judicial system.

Great health care debate needs to be had

The cost of health care is high. It is bloated with waste, ineffective practices and a lot of middle men who provide no services of their own, but rather broker those services for money, for a fee. The Affordable Care Act tried to recast the system, but it was a small first step and didn't address underlying issues.

The recent attempt at passing the American Health Care Act was in some ways, a reflection of the greater debate that needs to be had:

  • Is health care a right of all Americans?
  • Or is it a privilege for those who can afford it?

Depending on where you lie on the political spectrum likely drives your view point. But it is a heartfelt discussion that needs to be had at all levels of society, not just among the politicians we elect to represent us.

If affordable air ambulance transport is considered a right of the Montana citizen who needs it, then it's not overreach for the government to force the hands of service providers and insurance agencies to come up with a better way to provide the service. Unfortunately, the chances for service gaps to occur are increased, since litigation for reimbursement is expensive and time consuming.

Time will tell which way this situation will go.

About the author

Art Hsieh, MA, NRP teaches in Northern California at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. An EMS provider since 1982, Art has served as a line medic, supervisor and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook writer, author of "EMT Exam for Dummies," has presented at conferences nationwide and continues to provide direct patient care regularly. Art is a member of the EMS1 Editorial Advisory Board. Contact Art at Art.Hsieh@ems1.com and connect with him on Facebook or Twitter.

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