The air ambulance industry has again shot to the limelight, thanks to the failed attempt by the state of Wyoming to regulate it. The bone of contention this time around was the rising prices. The state has not been alone in raising this concern. California too had passed a law in this regard in the latter part of last year.
The major players in this controversy are mainly two – the air ambulance industry and the health insurance industry. Why are the two not coming to a common understanding? It is something that the people in general fail to understand. We take a closer look at to get a grip of the underlying issues.
Medical Necessity and Air Ambulance Services
The insurance industry is known to deny claims based on medical necessity. It is not that only air ambulance services are affected by it. All medical treatments must satisfy the medical necessity as defined by the insurance industry. However, the catch is that this ‘necessity’ is determined by the doctor appointed by the insurance company itself.
It is one of the primary causes for the high claim rejection rate that the medical industry sees today. In other words, while the patient goes by the judgment of the treating physician to avail a service, the insurance company’s doctor can overrule this judgment, albeit after the treatment or services is availed by the patient. The result: the claim might be rejected, and the patient might be compelled to pay out of pocket.
Out of Network Services
A health insurance company will not honor a claim, if the service is availed through a provider who is not in the network of the insurance company. However, when emergency strikes, it is usually the most easily and quickly available help that is sought. Network coverage is the last thing that lingers the mind. That said, what comes after is a claim rejection accompanied by a huge bill that the patient has to foot.
It is for the lawmakers to look at the fundamental flaws in the health insurance industry, lest high out-of-pocket expenses will continue to haunt the patients.