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Majority of air ambulance transports in '17 were out of network, GAO report says

Nearly 70% of air ambulance transports in 2017 resulted in out-of-network bills for patients, according to a new report from the Government Accountability Office, a nonpartisan congressional auditor.

After analyzing data from 20,700 transports, the report found that 69% of transports from air ambulances in 2017 were out of network, which can force patients to pay the majority of costly medical bills, according to the March 20 report.

Out-of-network billing can lead to a practice known as balance billing, in which the patient is required to cover the difference between the total bill and what their private insurance provider pays. This practice can lead to patients being responsible for the majority of a bill. Because of the high cost of emergency air transport, people can be responsible for tens of thousands of dollars in costs.

The GAO found that the median cost for helicopter transport and fixed-wing transport — the two primary modes of emergency air transport – was $36,400 and $40,600, respectively. Air ambulance prices in 2017 rose nearly 60% from 2012 prices, according to the report.

The GAO has highlighted rising costs before. According to a separate 2017 report, the median price for helicopter transports doubled from $15,000 to $30,000 between 2010 and 2014.

Ambulance companies told GAO that one reason for the high prices is the lack of contracts with insurance agencies. Because a particular individual rarely needs to use the service, very few insurance companies have negotiated contracts with the air ambulance companies, according to the report.

While the report analyzed cost data, the GAO did not analyze the extent to which patients experienced balance billing. The report also said that in-depth analysis of the industry is not possible because there is "a lack of comprehensive national data about the extent and size of balance bills, and air ambulance providers are generally not required to report such data."

In order to protect patients from unexpected, costly air ambulance bills, several states have introduced legislation to curb balance billing practices. The report highlighted legislation passed in Montana, which limited the amount covered by a patient to the insurance plan's cost-sharing amount.

However, the industry is governed by federal insurance and aviation laws that can limit the impact of state legislation, according to the report.