AHIP wants a judge to side with the federal government in an ongoing lawsuit over a ruling that would limit patient spending on off-network air ambulance transportation.
V summary Unveiled on Tuesday, the insurance lobby said the government’s rule is appropriate and in the interests of consumers and insurers.
The federal government’s process “reduces the likelihood and cost of resolving disputes, promotes predictability and efficiency, and helps correct the uniquely dysfunctional market dynamics that have for far too long imposed ultra-competitive air ambulance fees on patients,” writes AHIP in its brief report. .
The Air Medical Services Association sued the federal government in November, saying the temporary final rule gives insurers too much power to arbitrate bills, forces air ambulance providers to accept lower rates and even restricts access to emergency care.
The rule, which is part of a set of rules created to implement the No Surprise Law and Limit the Allocation of Costs for Offline Claims, went into effect on Jan. 1.
AHIP claims that air ambulance practices are an “extreme example” of what happens when providers have no incentive to join insurance networks. Roughly 69% to 75% of air ambulance travel is off-grid, compared to 51% of ground ambulance travel, the AHIP summary said, citing a 2019 Government Accountability Office report.
“Aviation air ambulance providers have used this offline status — and the associated ability to still send surprise bills to patients — to collect large payments from commercially insured patients,” writes AHIP.
In addition, due to exorbitant air ambulance travel fees, insurers may be paying for out-of-network air ambulances to help consumers avoid unexpected bills, writes AHIP.
In the absence of network agreements, the federal government’s decision that out-of-network billing arbitrators must first consider the plan’s median in-network rate for a service provided in that area makes sense, writes AHIP.
AHIP believes that increased predictability of out-of-network rates will benefit healthcare markets and patients. A more predictable dispute resolution process will increase the likelihood that parties will resolve disputes themselves, which can help them avoid arbitration costs.
“Even though the law prohibits unexpected billing, Americans will still pay for the increased costs of an unpredictable dispute resolution process through higher premiums,” AHIP says.
Health care provider groups in many medical sectors and specialties are warning about unexpected government billing rules that give insurers an edge in billing disputes. Another ongoing lawsuit filed by the American Medical Association and the American Hospital Association also casts doubt on the dispute resolution process.