16-May-2016 Source: AAMS
Mr. Jesse Laslovich, candidate for Montana state auditor, recently distributed an article, “Air ambulance flights add insult to injury,” suggesting air medical providers are the primary cause for the high cost of transporting critically ill patients. That position overlooks the insurance industry’s responsibility to cover their beneficiaries’ emergency medical needs.
Simply put, some insurance companies that cover health care provided in a brick and mortar hospital, refuse to negotiate fair in-network rates for those same services when they are provided by clinicians in the back of an aircraft.
Mr. Laslovich implies air medical providers refuse to negotiate with insurance companies. Air medical providers, including those operating in Montana, have negotiated fair agreements with insurers in many states, including some in Montana. Many of the “egregious” cases cited by Mr. Laslovich would have been covered in other states, resulting in no additional cost to the patient. Air medical providers welcome the opportunity to enter into agreements when they are fair and result from negotiations conducted on a level playing field.
In states like Montana, where one dominant provider controls over 60 percent of the insurance market, those dominant insurance companies are able to set allowable rates for medical providers at whatever level they want, offering a “take-it-or-leave-it” in-network agreement at their arbitrarily set rates. When an air medical provider is unable to accept this substantially under-cost amount, the insurance company settles with their beneficiary and leaves them, unknowingly, on the hook for whatever amount remains that their insurer refuses to cover.
The state auditor position regulates Montana’s insurance and financial-services industry. Mr. Laslovich has publicly said, “… I’ve dedicated my life to protecting Montana consumers, holding big insurance companies accountable, and fighting out-of-state special interests. … I’m running for state auditor to continue this work.”
What has changed since Mr. Laslovich made this statement last year? Where is the accountability of the private insurance companies? Why is air medicine considered unworthy of insurance coverage like any other emergency medical intervention? Insurance companies have a responsibility to their beneficiaries when they require life-saving transportation and treatment.
Air medical transports are highly-effective medical interventions, but are NOT appropriate for every patient. They are effective in cases of severe trauma, heart attack or stroke, when bringing high-levels of care to patients and swiftly transporting them directly to the right facility can significantly improve their outcomes. That is particularly true in rural areas, like much of Montana, where aircraft may function as the primary access to critical care.
Air medical providers do not decide who they will transport. Every air medical transport request comes from a medically-trained first responder or from a physician who needs to move a patient to a higher level-of-care. Air medical providers are obligated to act, by law, and must respond to every transport request, within safety standards, without knowledge of the patient’s ability to pay. They incur every cost, every time, without knowing if they will ever be paid.
Air medical providers save lives, but are not immune to the rapidly rising costs of medical care. One night in an ICU, for instance, can cost thousands of dollars. Creating those high levels-of-care inside aircraft that cost over $4 million and remaining ready to treat the most severely ill and injured patients 24-hours-a-day is also expensive.
The air medical industry does not want to see patients or their families placed at financial risk. We are committed to finding a reasonable solution to the issue of cost to consumers. We welcome the opportunity to work with all of Montana’s officials to find a practical solution. But any solution that would truly address the problem must also examine health insurance coverage policies, the appropriateness of allowable rates and transparency in health insurance policies regarding the potential financial responsibilities of the patient.
Montanans need timely access to life-saving emergency medical care and air medical providers remain ready 24 hours-a-day to provide that. Patients deserve transparent insurance policies that will be there for you as well. Let your elected officials know you want the insurance companies to pay their fair share and negotiate reasonable partnerships with air medical providers so patients aren’t victimized twice. Candidate Laslovich needs to be transparent about his agenda and motivation to overlook insurance company financial responsibilities when lives hang in the balance.
Richard Sherlock is the president and CEO of the Association of Air Medical Services.