In the model, NCOIL:
Requires a health plan without an “adequate network” of air ambulance service providers to provide a reimbursement rate equal to the state’s average.
Defines use of air ambulance service as medically necessary if a neutral certified medical professional or first responder requests the service, without regard to the patient’s ability to pay for the service.
Limits an insured patient’s liability for medically necessary air ambulance service to the patient’s copayment, coinsurance amount and deductible, whether or not the service provider is an in-network provider.
Calls for the service provider and the plan to resolve any reimbursement disputes through a dispute resolution program operated by the state’s insurance department.
The drafters suggest that the adjudicator reviewing a service provider’s claim should consider the costs associated with 24/7/365 readiness, the cost of uncompensated care, and the need for the provider to make a reasonable profit as well as costs related directly to the patient who triggered the claim.
NCOIL is a group for state legislators who have an interest in insurance. It has no ability to change state laws, but state lawmakers could use the NCOIL model as a starting point when drafting their own air ambulance claim bills.
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