It’s No Secret. {The Qualities Payors Seek In Air Ambulances}

For seriously ill and injured patients, air ambulance services can save their lives, but they can also be very expensive. Because of this, many insurance providers and assistance companies have stringent guidelines for the air ambulance services they will pay for. 

The insurance or assistance company will make arrangements and cover the costs, up to the policy limit, if it is determined that the patient needs to be transported right away by air ambulance to a higher level or more suitable medical facility. (Air Medical Transport – an Overview | ScienceDirect Topics, n.d.)

Insurers look for the following main elements in an air ambulance program: 
  1. A robust Safety Management System (SMS): A good safety record is something that insurers look for in an air ambulance program. Accordingly, the program must have a low incident rate and a track record of transporting patients safely. 
  2. Medical requirements: Insurers also want to make sure that the air ambulance program complies with the strictest requirements for health care. This calls for the program to have a medical director as well as medical staff that has received critical care and advanced life support training and certification. 
  3. Quality of care: Insurers also want to make sure that patients receive high-quality care through the air ambulance program. This simply means that the program must have established protocols for patient evaluation, treatment, and transportation, and the medical staff must be qualified to perform sophisticated medical interventions while in transit. 
  4. Open communication: The air ambulance program must have effective communication with the receiving hospital. This means that the agency should have procedures in place for informing the receiving hospital about patients and their treatment plans, and the medical staff should be able to give updates on patients’ conditions while they are being transported. 
  5. Cost-effectiveness: Insurers want to make sure the air ambulance program they are paying for is affordable. As a result, the program’s rates and billing procedures should be fair, and the medical staff should be able to deliver the proper level of care for each patient’s needs without making unnecessary interventions. 
  6. Compliance: Insurers also want to make sure that the air ambulance program complies with all pertinent laws and standards, including those set by the European Aviation Safety Agency (EASA) and the Federal Aviation Administration (FAA) for aircraft and equipment. 

“Air ambulance services frequently result in surprise medical bills due to individuals’ inability to select an in-network provider when faced with an urgent medical situation.”(Air Ambulance NPRM – Fact Sheet | CMS, 2021)

According to the No Surprises Act, providers of air ambulance services must provide HHS with information on a variety of topics. These include: transportation and medical costs, air ambulance bases and aircraft, the quantity and type of air ambulance transports, payor information, and information on claim denials. Plans and issuers must report information about claim data for air ambulance services under the No Surprises Act. 

While the goal of any air ambulance company is to provide the highest and safest level of care possible, there are times when current practices and standards can be improved. Transparency with insurance and assistance companies, as well as third-party accreditations and audits, can show not only the payer but also the patient being transported that you are committed to quality.

In general, insurance and assistance companies look for air ambulance providers that prioritize safety, quality of care, medical standards, transparent billing practices, and compliance.  

Insurers can give their policyholders the best care while also keeping costs under control by selecting an air ambulance program that satisfies these requirements.

To learn how Medical Transport Accreditation & Compliance can help meet the needs of insurance and assistance companies, contact us today.