Missouri Insurance Dept. Study Criticizes High Costs of Air Ambulances

A study has found that sick or injured Missourians who need air ambulance services often face steep medical bills, even if they have insurance.

The Missouri Department of Insurance, Financial Institutions and Professional Registration in early January issued a report detailing the high costs and sometimes aggressive collection efforts patients face if they can’t pay.

Air ambulances billed Missourians nearly $26 million for services in 2017, leaving patients with $12.4 million in bills after coinsurance, copays and deductibles. The report says that equates to an average cost of $20,000 per person.

The report found that insurance companies can’t negotiate prices with many air ambulance services because they are not “in-network” providers. And the study found many air ambulance companies use collection practices such as placing liens on homes or garnishing wages if patients are unable to pay the bills.

Medicare reimbursement rates for air ambulance services range between $3,368 and $6,404 and Medicaid reimbursements average $2,253. In contrast, private health insurers were billed an average of $41,321, of which they paid an average amount of $23,087, according to the report.

The report noted that air ambulance providers are not subject to price competition because patients have no say in how and by whom they’re transported and can’t avoid out-of-network providers.

Angela Nelson, director of market regulation at the insurance department and leader of the team that produced the report, said her agency can’t do much to lower prices other than respond to consumer complaints. Since 2013, the department has received 128 complaints or questions about air ambulance services, she said, and in 23 cases the department helped recover a total of $560,000.

The Association of Critical Air Transport, which includes air and ground ambulance providers, said in a statement that it was concerned about the exorbitant bills. It supports federal legislation that would improve consumer protections for air ambulance patients.