Insurance reimbursement as we’ve always known it is changing. Services we never dreamed would be covered or included “in network” will now receive reimbursement from commercial payers. Let’s talk about what has happened and what it may mean for ground and air providers.

We’ll start with the air portion and move on to ground. At the bottom of an article about a CEO change at Air Methods, was a note that they will partner with Anthem (the biggest Blue Cross in the country) to provide “air ambulance services as part of in-network health benefits to policy holders in Indiana, Kentucky, Missouri, Ohio and Wisconsin.” The remarkable part is that till recently air providers were hesitant to join insurance networks. On the other hand, insurers had some interest in network participation by air providers, but the reimbursement offered was not quite what air providers needed. The fact that such a large air provider and big insurer have found a way to work together is a good sign – for providers and patients.

Air is an expensive service to render. Patient bills have shocked the recipients and landed the industry on the six o’clock news. I did not read the contract, but I don’t imagine the air provider/insurer arrangement is perfect. However, it is a step toward recognizing the importance of air transports to patients. Patients could not continue to receive high bills; providers could not sustain themselves if they did not get paid (which patients are not consistently able to do).

In-network air participation is novel. It’s mirrors what many emergency ground 9-1-1 providers have experienced. 9-1-1 providers were also hesitant to join an insurance network and accept in-network payment rates. In fact, for many years I advised against 9-1-1 providers contracting with insurers. My thinking was that since an emergency is something usually covered by insurance, it was not in the best interest of the emergency provider to join an insurer’s network. What changed my mind was that insurers often sent payment directly to the patient and not the emergency provider. For an emergency provider located in an area with the large presence of an insurer, this was financially devastating. Many patients did not surrender their payments to the provider. The provider spent valuable time and resources chasing the patient payment with varying rates of success. Now I believe it’s worth exploring the possibility of provider participation with an insurer.

If network participation with an insurer will increase revenue for financially starving 9-1-1 services, then discussion is in order. This is especially true as it appears payer thinking is evolving toward the ambulance industry as evidenced by the movement toward payment of “treat, no transport.” Effective January 1st, Anthem moved toward payment for treatment without transport in fourteen states. State ambulance associations and provider organizations nationwide continue working with payers to commence payment for valuable services like treatment, no transport.

Payers need to manage costs. Many services provided by air and ground providers are already assuring that happens by getting the appropriate level of care to the patient. Whether that care be a wheelchair van transport, an EMS response without transport, or lifesaving air transport, the medical transportation industry cares for patients and helps curtail costs.

The evolutionary road being traveled by providers and payers is not an easy one. I have faith that if the discussions continue, we will get to better methods of reimbursement.

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About the author:  Maggie Adams is the president of EMS Financial Services, with 25 years’ experience in the ambulance industry as a business owner and reimbursement and compliance consultant. Known for a practical approach and winning presentation style, Maggie has worked with medical transportation providers and billing companies of all kinds to provide auditing services, assess their billing for best practices and support their billing and documentation training efforts. “Like” EMS Financial on Facebook, follow us on LinkedIn or for more info, contact Maggie directly at maggie@ems-financial.com or visit www.ems-financial.com