An executive committee at the NCOIL (National Conference of Insurance Legislators) has come up with a model law that will be used for handling air ambulance claims. The drafters of this law tried to maintain a balance between the interests of everyone involved – patients, air ambulances, and insurers.
Law Drafted in Accordance to the Federal Airline Deregulation Act
The drafters also had to comply with the rules of the Federal Airline Deregulation Act in addition to keeping the interests of each party in mind. Under the act, states have no control over the price and route as well as the service of air carriers, including air ambulances. The drafters took care to note this in a statement they presented in the bill introduction.
Details of the NCOIL Model for Air Ambulances
In the model, the NCOIL requires that a health plan that doesn’t have an adequate network of service providers provide a reimbursement rate according to the state’s average. The model defines the use of an air ambulance as medically necessary in case the service is requested by a first responder or a neutral certified medical professional, not considering the ability of the patient to pay for the service.
There is also a limitation in the liability of insured patients in case of medically necessary service. Their liability will only be limited to the patient’s coinsurance amount, copayment, and deductable regardless of whether or not the service provider is within the network. The model also requires that any dispute regarding reimbursement be resolved under the state’s insurance department, through a relevant dispute resolution program.
The drafters also made a suggestion for adjudicators that when they review a service provider’s claim, they should consider all the costs related to uncompensated care, 24/7/365 readiness, and the need to make a reasonable profit by the provider.
