The Moab Classic Air Medical helicopter flies about 300 patients a year. [Courtesy Classic Air Medical]

Emergency air transport is expensive, but federal legislation that recently went into effect aims to ensure that patients don’t have to weigh unknown costs against urgent medical needs when deciding whether to call for help or accept air transport in an emergency. The No Surprises Act, a provision of the Consolidated Appropriations Act, helps to protect people from “surprise billing” when they use medical providers outside of their insurance networks, especially in emergencies. The act was passed in late 2020 and went into effect at the beginning of this year. A company that conducts emergency medical air transport in Moab is now counting on the No Surprises Act to protect patients.

Classic Air Medical provides emergency air transport to the Southwest and Rocky Mountain regions. In a Feb. 11 press release, the company announced that it is ending a membership program that was implemented about a decade ago to help protect patients from excessive out-of-pocket costs, now that the No Surprise Act essentially accomplishes that.

Chad Bowdre, director of customer relations for Classic Air Medical, said that over the past decade, Classic Air Medical has become more savvy at effectively billing insurance companies for transport. It succeeded in bringing the average out-of-pocket cost for patients to about $200, partly because of more effective insurance billing practices and partly thanks to the membership program, which charged $69 a year for an individual or $79 a year for a couple to ensure no out-of-pocket costs for members who ended up needing emergency air transport. With the No Surprises Act in effect, the membership program isn’t needed. Classic Air Medical is owned by Intermountain Health Care, a not-for-profit healthcare system headquartered in Salt Lake City.

“We’re in a really good position being owned by IMHC,” Bowdre said, because it means the organization can focus on providing care and being safe without needing to make a profit.

Bowdre said that the company’s Moab base makes around 300 flights a year, serving not just Moab but also the surrounding geographic area, including Monticello, Canyonlands and Arches national parks, Nucla and Naturita in Colorado, and Green River. Other Classic Air Medical bases might make as many as 1,000 flights in a year. The company made just under 7,000 flights total in 2021.

The cost of emergency air transport is more than the fuel and time of the actual flight. It also includes keeping crews trained, prepared and on call and maintaining and updating equipment, both the helicopter itself and the advanced medical technology on board.

“It’s basically like an ICU,” Bowdre said of the medical equipment and supplies on a medical air transport helicopter.

The No Surprises Act does not cover emergency medical ground transportation—in other words, ambulance rides.

“Congress did not include ground ambulances in the No Surprises Act reportedly because so many emergency medical transport services are operated by municipal and county governments, and therefore, may be subject to additional types of state and local regulation,” according to a June 24, 2021 analysis by nonprofit healthcare system tracker partnership Peterson-KFF Health System Tracker. “Congress expressed interest in revisiting surprise billing for ground ambulances once it gathers more information.”

Andy Smith, director of Grand County Emergency Medical Services Special Service District, explained that ambulance rates are determined state-by-state, and sometimes county by county. In Utah, he said, ambulance rates are tightly regulated. Every service provider submits its financial data to the state each year—its operational costs and revenues. The state uses that data to determine set rates, and no service is permitted to make more than 10% in profits. The current Utah ambulance rate is between $931 and $1,838, depending on the level of care provided. Smith said that most EMS departments only collect about 50% of what they bill. Some make up for that by using volunteer EMTs. Especially in rural areas, where call volume is low, it can be hard to make enough revenue to employ full-time or even part-time ambulance staff. Grand County EMS employs both part-time and full-time staff; it makes up its revenue gap through receiving a portion of healthcare sales taxes and mineral lease funds from the county.

Smith said he does anticipate that Congress will eventually enact a bill similar to the No Surprises Act that applies to ambulances.

“It’s a great thing, in my opinion,” Smith said of the No Surprises Act. “It helps ensure that rates are somewhat reasonable.” He added that air medical costs are much more expensive than ambulance costs.

Under the No Surprises Act, patients are billed in-network prices, and providers and insurers negotiate the rest of the payment. Bowdre said that Classic Air Medical will work with patients without insurance, whether that’s because they can’t afford it or because they choose not to get insurance because they’re financially able to usually directly cover their own medical expenses.

“We’re not going to foreclose on grandma’s farm,” he said. “We’ll negotiate with them to something that’s reasonable…We work with absolutely everybody.”