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REACH Air Ambulance. Photo courtesy of

By Stacey Ingram

The critical need to maintain access to air medical services for residents of Nevada’s rural communities is undeniable. Each year, thousands of patients are flown from frontier towns to cities that have the facilities to treat the most seriously ill and gravely injured. By and large, Nevadans haven’t noticed this lack of easy access to Tier I and II trauma centers because air medical services have stepped up to fill the gap. 

However, if legislation currently being discussed in Congress is enacted as written, health insurers will have unprecedented power to determine how much they will pay for air medical services, regardless of the actual cost. This will put significant economic pressure on providers and may cause the closure of air medical bases in Nevada and nationally. 

Historically, health insurers have looked at air medical services simply as fast transport services called when patients need to be delivered somewhere as quickly as possible. They don’t seem to recognize these services as critical components of our national, rural health care system. They willfully ignore several important points, including:

First, to call air medical services “air ambulances” is really a disservice to the full range of care services offered during emergency transport. Unlike an ambulance, all medevac crews contain a trauma trained nurse, a trauma trained flight paramedic and, of course, a highly trained pilot. Their aircraft, whether a helicopter or plane, is the equivalent of a flying intensive care unit with significantly more advanced equipment than a ground ambulance, all of which has been miniaturized and made to fit in a tight space. Because of their trauma training, the crew is able to do significantly more in-depth medical interventions, if necessary, to assist the patient. 

Second, the costs associated with establishing a base of operations are significant. Not only the initial cost of the aircraft itself, but the land, buildings, ongoing maintenance, fuel and other daily costs incurred. What’s more, added to the team’s clinical abilities and equipment of the aircraft are critical safety components including ongoing pilot training, night vision capabilities and specialized radar.

Third, when called, air ambulances must respond. Unlike a physician who can ask what kind of insurance you have or decline to take a new patient, air medical services protecting Nevada’s rural residents must answer when called by a physician or first responder. They are only allowed to decline a flight for a limited number of safety reasons. Regardless of a patient’s ability to pay, air medical services will deliver care and hope the patient, their insurance or a government program will pay.

Because of this requirement, insurers have been taking advantage of air medical providers, and by extension, Nevadans. According to a recent YouGov Survey of 1,240 American adults, 90 percent consider air ambulances a critical service in health care, with 95 percent agreeing that that these services help save lives. Yet insurers immediately reject more than half of air transport claims, despite the service having been ordered by a doctor or first responder — exposing patients to bill balances of thousands of dollars. Or worse, insurers refuse to put air medical services in-network.

To address surprise billing, some policymakers propose tying reimbursement rates to “a median in-network rate,” but with insurers currently refusing to negotiate rates with air ambulances, there are often no fair rates to benchmark a median rate against.

Today, 85 million Americans, and hundreds of thousands of Nevadans in rural areas rely on air ambulance services to access a Level I or Level II trauma center within 60 minutes. This so-called “Golden Hour” can often make the difference between complete recovery and a lifetime of long-term disabilities or even death. If hospitals keep closing and air ambulances aren’t there to fill the gap, people will die when they should have survived.

Surprise billing needs to be addressed, but we need to be sure the solution won’t make the crisis in rural care worse. With careful consideration, Congress should be able to protect patients and access to air medical services.

Stacey Ingram is the Program Director for REACH Air Medical Services. 

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