North Dakota Insurance Department Appeals Court Ruling on Air Ambulance Balance Bills

The North Dakota Insurance Department has appealed a ruling from a U.S. District Court invalidating a law protecting individuals with health insurance from receiving large and unexpected balance bills to the 8th Circuit Court of Appeals, North Dakota Insurance Commissioner Jon Godfread announced.

The appeal is in response to a federal judge’s split decision regarding a consumer protection law enacted by the state during the 2017 legislative session.

The law was written to protect consumers with health insurance from receiving balance bills from air ambulances. It prohibits air ambulance subscription agreements from being sold and requires hospitals to inform patients in non-emergency situations about which air ambulances have contractual agreements with the patient’s health insurance company so patients can make informed decisions about which air ambulance company they should use.

The court’s decision invalidated the portion of the law that protects North Dakotans from receiving balance bills from air ambulances. However, the provision requiring hospitals to inform patients in non-emergency situations about which air ambulances have contractual agreements with the patient’s health insurance company and the provision prohibiting the sale of air ambulance subscription agreements both remain valid and enforceable by law.

Leading up to 2017, the insurance department had received a number of complaints from North Dakota consumers with health insurance who had received balance bills from air ambulance companies averaging more than $35,000.

“I will continue to fight to protect North Dakotans from the completely unfair practice of air ambulances balance billing individuals with health insurance,” Godfread said in the department’s announcement. “No one deserves to face financial ruin because of something as out of their control as an air ambulance ride.”

A final decision from the 8th Circuit is not expected for at least a year.

Godfread in late January was nominated by the National Association of Insurance Commissioners (NAIC) to serve as the state insurance regulator on the national Air Ambulance and Patient Billing Advisory Committee. The committee was created by Congress to review options to improve the disclosure of charges and fees for air medical services, better inform consumers of insurance options for such services and protect consumers from balance billing.

The Missouri Department of Insurance also has been critical of air ambulance billing practices. The department in early January issued a report detailing the high costs and sometimes aggressive collection efforts patients face if they can’t pay. According to the report, 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.