Air Ambulances: What You Need to Know

Air ambulances provide a vital service to Montanans and are an integral part of Montana’s health care system.  From rescuing an injured hiker in the wilderness to quickly transferring an ill child to a specialty care hospital, air ambulance services make all the difference when time is of the essence. Air ambulances provide Montanans with timely, quality medical treatment when it’s needed most.

It’s important to know that air ambulance services can also be very expensive. A typical air ambulance bill can cost tens of thousands of dollars, and while insurers have network agreements with most air ambulance carriers, there are some that remain out-of-network, which could result in a balance bill delivered to your mailbox.

Montana’s “Air Ambulance Hold Harmless” statutes, found at § 33-2-2301 of the Montana Code Annotated (MCA), work to protect many of our residents when they receive a balance bill from an out-of-network air ambulance provider. These laws require insurers to assume responsibility of the balance bill, and work with the air ambulance carrier to come to an agreed upon amount. While you’re still responsible for your regular cost-sharing (copayments, coinsurance, and deductibles) you won’t be held responsible for the balance bill.

This law only applies to out-of-network air ambulance providers that aren’t owned or controlled by a Montana hospital. The law doesn’t apply to certain health plans if the Commissioner’s office doesn’t regulate them. Some of these plans include:

  • Federal Employees’ Health Benefits Program
  • Medicare Advantage Plans
  • Medicaid
  • Workers Compensation Insurance
  • Self-Funded Employer-Sponsored Group Health Plans; and
  • State of Montana Health Plan

The following FAQ provides more information.

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Frequently Asked Questions

Here are some questions consumers often have when it comes to air ambulance flights. You can also call the Office of the Montana State Auditor, Commissioner of Securities and Insurance at (800) 332-6148 for further assistance.

Most major medical insurance policies and employee benefit plans provide some form of air ambulance coverage. However, the policy may not cover the entire charge. Here are a couple of important factors that can have a impact on your air ambulance bill.

  • Provider network: It’s important to know which air ambulance providers are “in-network” under your insurance policy or employee benefit plan. In-network providers agree to accept a set allowable amount as payment in full, but you are typically still responsible for any deductibles, copays, and coinsurance. Most Montanans live within range of an in-network provider. “Out-of-network” providers have not agreed to the allowable amount. Under MCA 33.2.2302, your insurer will assume responsibility and notify the air ambulance company of the assumption of any balance in excess of the allowed amount not later than the date the insurer issues payment for your air ambulance services.
  • Cost sharing: Regardless of whether you use an in-network or out-of-network air ambulance provider, you’ll still likely be responsible for your usual cost sharing obligations under the policy. These include your deductible amount, any copayments, and any coinsurance (a percentage of the amount owed after deductible and copayments). Even with an in-network provider, you may still have a significant out-of-pocket expense.
For emergency transports, you do not need to request preapproval by your insurer or employee benefit plan. However, preapproval may still be necessary for non-emergency flights.

If you have time, it is always a good idea to contact your insurer or plan to learn about your air ambulance provider network, what you can expect to pay out of pocket, and other coverage details.

If your health insurer or employee benefit plan denies payment for an air ambulance claim, you have the right to appeal the decision with your insurer or plan. In most circumstances, after the appeal process is complete you can also request that an impartial third party review your insurer’s determination and, if appropriate, require the insurer or plan to pay the claim. Instructions on appealing a claim denial are located in your insurance policy or summary plan description, as well as the explanation of benefits you receive.

You can also contact the Commissioner’s office for assistance in appealing a claim at (800) 332-6148.
Click here for more information on your appeal rights.

No air ambulance company is currently registered with the Montana Insurance Commissioner to sell air ambulance memberships.

An emergency medical condition is one that could reasonably be expected to result in serious jeopardy to the health of the patient or her unborn child; serious impairment to bodily functions; or serious dysfunction of a bodily organ or part.

If an emergency medical condition exists, an air ambulance provider may not consider the patient’s insurance status or other ability to pay. Likewise, an insurer or employee benefit plan may not require preapproval of an air ambulance transport in an emergency situation. In an emergency, the patient usually does not have the opportunity to request transport by a specific air ambulance provider.

Different rules apply in a nonemergency. The air ambulance provider is allowed to consider the patient’s ability to pay, and may require payment in advance. Your insurer or employee benefit plan may not cover a nonemergency transport, particularly if that transport is not considered medically necessary. However, in a nonemergency scenario, the patient or patient’s family is able to shop around for the most affordable air ambulance transport, preferably from an in-network provider; a hospital case manager can assist with this process.

Emergency Care Provider
An air ambulance that transports a patient from the scene of an accident most likely was requested by an on-scene emergency care provider.

The Treating Physician
For a hospital-to-hospital transport, the treating physician will decide whether an air ambulance is needed, and which to use.
Depending upon the urgency of the transport to stabilize a patient a doctor might speak with the patient’s family about transport options and preferences on the hospital to which the patient will be transported.

The following situations are possible:

MEDICARE:
A patient covered by Medicare is responsible for the deductible and coinsurance unless that patient’s Medicare supplemental policy covers the non-Medicare-covered costs. With respect to balance billing, Section 1834 (I) of the Social Security Act requires mandatory assignment for all ambulance services. This means that ambulance providers and suppliers must accept the Medicare allowed charge as payment in full and not bill or collect from the beneficiary any amount other than any unmet Part B deductible and Part B coinsurance.

HEALTH INSURANCE/EMPLOYEE BENEFIT PLAN:
If you have health insurance or are covered by an employee benefit plan, you will be responsible for any applicable deductibles, copayments, and coinsurance.

NO INSURANCE:
If you do not have health insurance, Medicare, Medicaid, you face the full cost of whatever the air ambulance determines is the charge. A private air ambulance company may have payment or charity care terms. An air ambulance affiliated with a hospital may have a charity care policy.