February 16, 2023
Air ambulance services often result in surprise medical bills due to individuals’ inability to select an in-network provider when faced with an urgent medical situation. For example, a 2019 study by the Government Accountability Office (GAO) found that in 2017, 69 percent of air ambulance transports of privately insured patients were out-of-network. Additionally, in 2017, the median price charged by providers of air ambulance services for privately insured patients was $36,400 for helicopter transport and $40,600 for fixed-wing transport.
In an effort to address the high costs of air ambulance services, Congress added requirements regarding air ambulance services in the No Surprises Act. In addition to including air ambulance services in the ban on surprise billing, Section 106 of the No Surprises Act also requires health plans and health insurance issuers to disclose specific data to the Department of Health and Human Services (HHS) regarding the use of air ambulance services. The rule requires plans and issuers to report the following data for each claim for air ambulance services received or paid for during the applicable plan year:
- Identifying information for the group health plan, plan sponsor or issuer, and any entity reporting on behalf of the plan or issuer, as applicable
- The type of coverage (e.g., self-funded plans offered by a large employer, fully insured large groups, etc.)
- Date of service
- National Provider Identifier (NPI) information
- Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) code information
- Transport information including aircraft type; loaded miles; pick-up and drop-off zip codes; whether the transport was emergent or non-emergent; whether the transport was an inter-facility transport; and, if available, the service delivery model of the provider (e.g., government-sponsored, hospital-owned, etc.)
- The provider’s contract status with the plan or the issuer
- Claim adjudication information, including whether the claim was paid, denied, or appealed, and the denial reason and appeal outcome, as applicable
- If applicable, claim payment information, including submitted charges, amounts paid by each payor, and cost-sharing amount
The Air Ambulance Report reflecting the data for the 2022 calendar year reporting period is due to CMS after the final rules are published. We will notify you of the date as soon as it is available. Premera will submit a consolidated report that includes data for our group (fully insured, OptiFlex, and self-funded) and individual lines of business. Once complete, we will provide confirmation that the reporting has been submitted.