OPINION

With Insurers, Actions Speak Louder Than Words

In the world of politics and policymaking, words are king. Lawmakers, lobbyists and reporters examine every word, looking to interpret the message and subtext behind each policy debate. 

But as is so often true, actions speak louder than words. You can see this play out in the larger debate around surprise billing and emergency air ambulance services, where insurers say they want to do right by their patients but increasingly deny coverage for these life-saving services.

Congress is evaluating proposals to address surprise medical bills, some of which include provisions that would reduce access to air ambulance services. If Congress intends to address surprise billing for air medical patients, it must examine the actions of private insurers.

According to recent reports, the not-for-profit Health Care Service Corp. (parent company of the Blue Cross Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma and Texas) received a $454 million tax refund for the first half of the year, bringing its net profits in 2019 to more than $2.3 billion. In addition, this year they are required to return $323 million of unpaid rebates to consumers who were overcharged.

Profits such as these are generated in part by the routine denial of coverage. We especially see this with insurers deeming these emergency services not “medically necessary” despite the fact that 100 percent of all air ambulance transports are only deployed by a trained first responder or doctor. 

Ninety percent of air ambulance transports are for people who have suffered a serious cardiac event of trauma. To say these trips are not medically necessary is simply wrong, yet private insurers increasingly deny emergency air medical transports on the basis of “medical necessity” — after the fact — in more than 40 percent of privately insured claims. 

Another way in which private insurance companies deny coverage is to refrain from going in-network with air medical providers. While many air ambulance providers are working to join insurer networks, with some recent success, some insurers have gone even further by refusing to bring this life-saving service in network. Shifting the cost of emergency services to patients allows insurers to continue to rake in massive profits while leaving their members left to foot the unpaid bill.

Congress must keep these practices in mind as it works to address surprise billing. Legislation being considered — Section 105 of S. 1895 — would allow insurers to pay providers a benchmark rate, essentially allowing insurance companies to set their own prices. Benchmark rates will put additional strain on air medical providers and the patients who rely on their service. 

When asked if insurers should be responsible for covering emergency health care claims, a survey by the American College of Emergency Physicians found that 81 percent of Americans believe their insurance companies should pay for surprise medical bills. That’s why consumers pay monthly premiums, after all: to get the care they need in an emergency. In fact, a Sierra Health Group study calculated that air medical services could be covered by an increase of only $1.70 to monthly insurance premiums.

Rather than giving insurers all the authority to determine what they will cover or how much they will reimburse, Congress should be focused on directing insurers to either cover health benefits — particularly emergency services — or lower overall health care premiums. 

Lawmakers should turn words into action and oppose setting arbitrary benchmark rates that will contribute to even bigger profits for insurance companies and do nothing to address surprise billing. 

 

Carter Johnson is a spokesperson for the Save Our Air Medical Resources Campaign, a national campaign dedicated to preserving access to emergency air medical services for Americans across the country.

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