Air ambulance charges rise 28% in four years, analysis finds

Photo: Keith Brofsky/Getty Images

Costs linked to helicopter air ambulance services among commercial insurers have risen 27.6% since 2017, a substantial increase that has inflated costs from $19,210 to $24,507 in 2020, according to a new analysis from FAIR Health.

The average estimated allowed amounts rose 76.4%, from $8,855 to $15,624. The average Medicare reimbursements rose 4.7%, from $3,071 to $3,216.

That increase was found primarily among fixed-wing, or airplane ambulance transports. Over the same time period, rotary-wing air ambulance transports, or helicopters, also saw an increase in average charges – 22.2% – from $24,924 in 2017 to $30,446 in 2020. The average estimated allowed amounts rose 60.8%, from $11,608 to $18,668. The average Medicare reimbursements rose 4.7%, from $3,570 to $3,739.

Air ambulance costs include an initial or base fee, and a mileage fee – or the mileage rate multiplied by the miles per trip.

The top diagnoses associated with fixed-wing air ambulance rides from 2016 to 2020, as identified by ambulance providers, were, from most to least common: digestive system issues; heart attacks; sprains, strains, breaks and fractures; chronic respiratory diseases; and general signs and symptoms involving the circulatory and respiratory systems.

The top diagnoses linked to rotary-wing air ambulance rides from 2016 to 2020 were cerebrovascular issues and diseases, heart attack, head injury, injury to body, and stroke.

Along with the costs linked to those services, FAIR Health examined the states that were using the highest volumes of air ambulance services. The states with the highest use of fixed-wing air ambulance transport as a percentage of all medical claim lines in 2020 – in order from highest to lowest use – were Alaska, Wyoming, South Dakota, Montana and New Mexico. The five states with the lowest use, in order from lowest to highest, were Virginia, Kentucky, New Hampshire, New Jersey and Vermont.

The states with the highest use of rotary-wing air ambulance transport as a percentage of all medical claim lines were Idaho, South Dakota, New Mexico, West Virginia and Wyoming.

In emergencies, in the period 2016-2020, patients transported by air ambulance were much more likely to be admitted as inpatients to a hospital than patients transported by ground ambulance, the analysis found.

WHAT'S THE IMPACT?

Air ambulances are typically used in emergencies to transport critically ill patients, often in life-threatening situations, to a hospital or for transportation between hospitals when patients need a higher level of care. 

Patients generally have no control over whether to use an air ambulance, or which air ambulance provider to use. Because of that, surprise, or balance bills – in which a patient is billed for out-of-network emergency services, or for nonemergency services unexpectedly rendered by an out-of-network provider at an in-network facility – occur frequently with air ambulance services. 

As a result, though they affect relatively few people, air ambulance services have been the subject of substantial policy focus.

A number of states have attempted to regulate air ambulance charges. But such attempts have frequently been overturned by court rulings that state efforts to regulate air ambulance rates are preempted by the Airline Deregulation Act of 1978.

THE LARGER TREND

On the federal level, the No Surprises Act, signed into law in December 2020 as part of the Consolidated Appropriations Act of 2021, contains provisions to protect consumers from surprise bills, including balance bills from out-of-network air ambulance service providers. The No Surprises Act also authorizes states to enforce certain provisions with respect to air ambulance providers.

Despite the policy importance of air ambulances, there have been relatively few in-depth studies of the use of air ambulance services. Using FAIR Health data, the U.S. Government Accountability Office conducted a study that focused on financial aspects, showing that 69% of air ambulance transports were out of network in 2017.
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com