QUINCY -- U.S. Sen. Claire McCaskill has proposed legislation aimed at protecting consumers from "staggering air ambulance bills."
The Missouri Democrat introduced the bill last week, saying it will bring greater transparency and consumer protections to the air ambulance industry while allowing states to better regulate medical costs associated with air ambulance services.
Air ambulances "are currently operating in a gray area between health care and aviation, and have managed to not be held accountable by anyone--and it's time for that to change," McCaskill said in a news release.
"This bill will allow states to properly regulate air ambulance costs, which have skyrocketed in the last decade, and give consumers much-needed protections."
The air ambulance industry offered a cool reception to McCaskill's legislative proposal.
An industry group dubbed Save Our Air Medical Resources issued a statement saying McCaskill's bill "would have a devastating effect on millions of Americans' access to emergency air ambulance services."
SOAR argues that the bill would put up barriers to air ambulance services that strive to get patients to the nearest medical facilities in the quickest and most efficient manner -- regardless of multiple political jurisdictions.
"Instead of allowing air medical providers to transport patients to the nearest, most-appropriate medical facility, as is the case today, this change would cause air medical providers to only look to in-state facilities, which could be farther away and less appropriate for the patient," SOAR's statement said.
"In short, this seemingly small change could have a devastating effect on patients facing life-threatening emergencies, their access to care, and ultimately, their health outcomes. And it does nothing to address the issue of patient bills."
In late April, McCaskill launched an inquiry into air ambulance services and insurance companies after a series of news reports appeared in the St. Louis Post-Dispatch that raised concern about billing practices that ended up costing some families thousands of dollars.
In one case that received widespread attention, the Post-Dispatch told of a St. Louis County boy who was airlifted to a hospital after fracturing his skull in a fall during a family camping trip in 2016. The family's health insurance company -- Anthem Blue Cross Blue Shield -- only covered $11,787 of the $44,232 Air Evac Lifeteam's bill, leaving the family to pay the $32,445 balance.
Since then, other stories have surfaced involving other families and people stuck with significant bills for using air ambulance services.
McCaskill's proposed Air Ambulance Consumer Protection Act would provide more oversight over billing practices and establish a "complaint hotline" for consumers.
"You never plan to be in a situation that requires an air ambulance, but in an emergency, a family doesn't have time to read the fine print and try to figure out which company is in-network or if their insurance will actually cover the costs," McCaskill said.
Air Evac Lifeteam has been providing air ambulance services in a 70-mile radius of Quincy ever since a local base was established in 1997.
Shelly Schneider, a public relations spokesman for the company, said Quincy's Air Evac system has provided an average of one flight a day over the years. That would work out to about 7,665 flights over the 21-year period.
The flights are expensive because Air Evac maintains 14 full-time employees at each of its bases, including nine in Illinois.
The Quincy base, for example, has four full-time pilots, four full-time flight nurses, four full-time flight paramedics, one aviation maintenance technician and one program director.
Flight teams work in 24-hour shifts, with each team consisting of one pilot, one nurse and one paramedic.
Schneider said patrons of Air Evac can pay a $65 membership fee that covers all costs associated with a flight -- beyond what is paid by Medicare, Medicaid or the person's personal insurance.
For example, if a person has a membership and also is covered by Medicare, Medicaid or a commercial insurance policy, the amount paid by Medicare, Medicaid or the insurance carrier "is considered payment in full," Schneider said.
"If you have the membership and you are not insured, then you will be billed at the Medicare allowable rate," she said.
Schneider said the controversy involving the St. Louis County boy whose family was stuck with the $32,445 bill was attributed to a decision by Anthem BCBS several years ago to cut its reimbursement race for air medical carriers by 70 percent. She said that has led to numerous complaints for families receiving higher-than-expected bills to compensate for the low reimbursement.
In several other cases cited in Post-Dispatch stories that involved extremely high billing balances, "all of them had Anthem," Schneider said.
"The vast majority of the commercial insurance payers do a fair reimbursement," she added.
She said someone who doesn't have a membership but is covered by Medicare and Part B supplemental insurance "is going to come close to not having a bill" because those forms of insurance "typically cover it."
Likewise, she said, "if you have Medicaid, you're not going to get a bill."
People without adequate insurance, however, run a risk of facing a bigger bill if they use Air Evac's services without paying the membership.
"If you don't have the membership, you might want to check with your insurance" to see how it handles payments for air ambulance services, Schneider said.
She said the cost for Air Evac memberships is scheduled to rise to $85 starting June 1, except for people 60 and older, who will continue to pay $65.
"There is no downside" to having a membership, Schneider said. "Even if you have good commercial insurance, I think this is a no-brainer."