Can you imagine the kind of injury that has the potential to change who you are at your core? An injury that could affect your memory, your likes and dislikes, your hobbies and so much more. A brain injury changes your life in an instant.
The annual impact of brain injuries in the United States is significant — every year, at least 3.5 million people suffer one. While no two brain injuries are the same, they all require the highest-quality care. The sooner a person can receive treatment, the greater his or her likelihood of recovery.
Air medical services are critical for those who’ve suffered a brain injury. Air ambulances care for and transport patients to the nearest medical facility as quickly as possible, which is especially important in rural areas, where increasing hospital closures pose a huge barrier to timely care.
Now, consider the scenario again — you or your loved one has just suffered a brain injury. Your life, and the life you remember, was saved not only because you arrived at the hospital on time thanks to a rapid transport by an air ambulance, but because of the care you received on-board during the trip to the emergency room.
Then imagine that, after your life was saved, the unthinkable happens — you get word that your private insurer will not cover the cost of the air medical ride. Unfortunately, this isn’t a rare occurrence.
Across the health care system, private insurers are leaving patients to fend for themselves after receiving medical care that saved their life. While many private insurers do right by their members and cover the critical emergency services they need at a fair rate, others flatly deny payment for these services.
Some may claim — after the fact — that the emergency care was not “medically necessary.” They argue the emergency room visit, the consultation by a more specialized doctor, or the transport to a hospital more suited to handle brain injuries, for example, wasn’t necessary.
These kinds of policies discourage people from seeking the care they truly need, which, especially in the case of brain injuries, can mean the difference between a full recovery and a life of challenges. In the case of air ambulances, some insurers refuse to pay for the transport, even though a trained first responder or physician deemed the rapid transport to a hospital or medical facility and advanced care during the ride critical.
Other insurance company tactics include pursuing narrow networks of providers to increase their own bottom line, leaving patients with a large bill they never expected.
No patient — especially one recovering from a brain injury — should worry about paying for care, or worse yet, put off necessary treatment after an injury, such as a concussion, for fear of not being able to afford it.
Air ambulance providers depend on private insurance reimbursements for funding, as Medicare and Medicaid only reimburse about half the cost of an air medical flight. Because more than 70 percent of air medical transport patients are covered by some form of government insurance, or not covered at all, emergency air medical transports are severely underpaid.
The result is extreme cost-shifting to those patients who have private insurance, who then must support the entire system. It’s wholly unsustainable and could eventually lead to air medical services being severely reduced.
During March, the Brain Injury Association of America wants to #ChangeYourMind about brain injuries. We want to increase awareness, correct common misconceptions, educate on the prevalence of these injuries and the needs of individuals who are injured, and provide tools and information for anyone to advocate for access to care after brain injury. A portion of that last goal is ensuring that individuals who suffered a brain injury get the care they need as quickly as possible, including transport and care by air medical services.
Brain injuries are unpredictable without the additional worry and stress of finances. Every individual who suffers a brain injury must have access to emergency services that save lives without bankrupting patients and their families.
The solutions are two-fold: Private insurers must step up to the plate and adequately cover air ambulance services, and Medicare and Medicaid reimbursement rates must be updated to reflect the true costs of care. Only then can we protect access to the services we need to ensure a speedy recovery.
Susan Connors is the president and chief executive officer of the Brain Injury Association of America. Richard Sherlock is the president and chief executive officer of the Association of Air Medical Services.
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