A working group trying to find a way to reconcile the difference between Montana air ambulance companies’ bills and insurers’ reimbursement rates discussed proposed legislation that would require insurers and out-of-network providers to negotiate a payment, leaving the patient responsible only for the deductible and co-insurance costs required under their policies.
The legislation would require an independent review if negotiations fail.
The Legislature’s Economic Affairs Interim Committee appointed the Air Ambulance Working Group to try to develop a solution after residents complained about receiving air ambulance bills for tens of thousands of dollars from out-of-network providers after their insurance companies made their payments. Providers say insurers won’t agree to adequate payments, and insurers argue providers won’t disclose their actual costs so they can set reasonable rates.
Under the federal Airline Deregulation Act, states cannot regulate the prices, routes or services of air carriers.
The draft legislation being discussed Friday would require insurance companies to assume the covered person’s responsibility for amounts charged above their deductible and co-insurance costs. The insurer would then be required to pay either the billed charges, an amount negotiated with the provider or take the case to dispute resolution and pay the amount determined by the independent reviewer.
The reviewer could take into account the qualifications of the air ambulance crew, the level of services provided, the fees usually charged for similar services and the amount accepted as payment in full for similar services in determining a fair reimbursement. The legislation would set penalties for disregarding an order of the independent reviewer.
Several group members questioned whether the proposed legislation might create an incentive for providers to remain out-of-network because they would have the possibility of negotiating a higher rate.
The incentive for being in network, others noted, was the guarantee of being paid in a timely fashion.
Bill Bryant, who represents a coalition of air ambulance groups, asked if the interim committee was going to recommend that the state increase its Medicaid reimbursement rates, which would remove some of the need to transfer costs to other patients.
Jesse Laslovich, chief counsel in the state Auditor’s Office, said that was being discussed.
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