The Air Ambulance Issue Gets Even Crazier
Surprise medical bills, a congressional fix to protect consumers, and dark-money designed to kill that legislation – could the air ambulance disputes take any wilder curves? Just when you thought the disputes might get a conventional resolution through an appeal to the United States Supreme Court, a bipartisan bill to protect consumers, insurers and health care providers has been revealed.
Last week sponsors in Washington introduced a bill with widespread support to end the practice by some health care providers of billing patients for extraordinary fees when they receive treatment from providers who are not in their networks. The bill reportedly has the support of four powerful congressional committees: the House Energy and Commerce, Education and Labor, and Ways and Means Committees, and the Senate Health, Education, Labor and Pensions Committee.
And if the bill becomes law, it could have a direct impact on how air ambulance providers are compensated in the group health and workers’ compensation arenas. A 372-page bill – The No Surprises Act – was included in a year-end funding package last Friday. It requires providers and payors to negotiate an agreed-upon rate or bring their dispute to a mediator. Politico reports that air ambulances, which can often leave patients with bills worth tens of thousands of dollars and had been a sticking point in negotiations, would also be included in the surprise billing ban.
The House Ways & Means Committee describes four key elements of the legislation: ending surprise medical bills, providing new patient protections, creating a mediated dispute resolution process, and offering help for individuals without health insurance or electing to pay cash for their treatment.
The American Prospect writes that similar legislation was upended last year shortly before it was to be included in a year-end omnibus spending proposal. The article lays the blame at the feet of dark money allegedly funneled by a private equity group to a lobbying organization called Doctor Patient Unity. The lobbying group is reported to have launched a multimillion-dollar campaign in July of 2019 that ultimately reached nearly $54 million.
The congressional activity has taken place just as the United States Supreme Court docketed an appeal by PHI Air Medical challenging last year’s Texas Supreme Court ruling in air ambulance litigation pitting Texas workers’ compensation carriers against air ambulance companies and involving multi-million dollar in potential workers’ compensation medical benefits reimbursement. PHI’s Petition for Writ of Certiorari argues that the Texas decision “squarely conflicts” with decisions from the fourth, tenth and eleventh circuit courts of appeals.
Air ambulance providers in the litigation want no regulation on the amount owed for their services while comp carriers have argued the providers are subject to regulation by the Texas Department of Insurance, Division of Workers’ Compensation.
In Texas Mutual Ins. Co. v. PHI Air Medical, LLC, a divided Texas Supreme court sided with the carriers, holding that the Airline Deregulation Act “does not preempt Texas’s general standard of fair and reasonable reimbursement as applied to air ambulance services, nor does it require that Texas compel private insurers to reimburse the full charges billed for those services.”
The court reversed the judgment of the court of appeals and reinstated the trial court’s judgment, which declared that Texas law is not preempted. The case is a huge victory for Texas workers’ compensation carriers and their policyholders.
If you have questions about the air ambulance legislation or litigation, please contact Steve Tipton in our office.
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