‘MISSISSIPPI INSURANCE DEPARTMENT May 25,2018 ‘The Honorable Roger Wicker United States Senator 555 Dirksen Senate Office Building ‘Washington, D.C, 20510 ‘The Honorable Cindy Hyde-Smit United States Senator 113 Disksen Senate Office Building ‘VIA: ELECTRONIC: DELIVERY, USPS ‘Washington, D.C. 20515 Re: Air Ambulance Legislation eat Senators: AAs the Commissioner of Insurance forthe State of Mississippi, I am writing to request support forthe inclusion of language within the Federal Aviation Administration bill that would provide consumer protections ftom unfair billing practices. Federal regulation addressing the regulatory ‘paps in emergency air transport services is necessary to allow state regulators to identity deceptive practices and provide transparency inthe ir ambulance industy. ‘Balance billing occurs when health care providers bill consumers the difference between the provider’s charges and the insurance carer's allowed amount. The expansion of the number of ‘ir ambulance providers operated by for profit carriers has contributed tothe rise of balance billing issues. To maintain a competitive marke, air ambulance providers are veering away fom contracting with health insurance cartiers and hospital based facilites. These providers supplement their revenue with significant cost increases for consumers, insures, and hospitals. Another major issue resulting in balance billing issues is hospital and health systems consolidation. Patients are unknowingly transported to out of network facilities under the assumption the bill is covered by insurance and eventually billed forthe charges.Consumer complaints have increased rapidly across the nation as consumers ae progressively being balance billed by air ambulance operator, inthe amount of tens of thousands of dollars. Fees charged by traditional medieal services ate regulated under the A fordable Care Act. Conversely, ar ambulance providers maintain their fees are under the jurisdiction ofthe Aviation ‘Deregulation Act of 1978 (ADA), which probibits state regulation of air cartirs withthe intention of encouraging a competitive market, Without further federal guidance, Mississippi ‘remains amongst the pool of state insurance regulators that have experienced high volumes of ‘consumer complaints against air ambulance operators, Please see examples below: 1, A 8-month old baby was actively seizing and in severe respiratory distress when he arrived at King's Danghters Medical Center in Brookhaven, Mississippi. In order for him to receive immediate care ftom a pediatric neurologist, he was ar lifted from Brookhaven. to Blair E, Batson Hospital for children in Jackson, Mississippi. The insurance easier paid the allowable amount of $9,251.08. The ambulance company billed $45, 443.21, leaving the family owning $36,192.13. 2, A'man in Greenwood, Mississippi fell and sustained a serious head wound, He was, ‘ansparted by air ambulance ffor a helipad in Greenwood to UMMC in Jackson, pp. The insurance earrer paid the allowable amount of $7,192. This man and his family were balanced bill $50,930.00 by the air ambulance provider. 3, A S-month old baby diagnosed with Respiestory Syncytial Virus (RSY), sepsis, and ‘pnoumnia in both lungs was transported from North Mississippi Medical Center to Le ‘Bonheur Children’s Hospital in Memphis, TN. The insurance carrier paid the allowable amount which was 25% of the total bill of $33,500. The infants family was balance billed §25.248 by the air ambulance provider. ‘The House of Representatives adopted the FAA Reauthorization Act of 2018 on April 27, 2018. ‘Seotion 412 of ELR-4 supports language offered by Representative Rob Woodall. Under the ‘Woodall Amenciment, an advisory committee would be established to make recommendations for rulemaking. The committee would be comprised ofthe US Secretary of Transportation, state insurance regulators health insurance providers, consumer groups, and air ambulance operators ‘The committee would asitin establishing protections for consumers of air ambulance operators and ensure air ambulance operators provide clear disclosure of charges within any invoice or bill by separating air transportation fiom non-transporation services. “The Senate is considering drafting its own version ofthe FAA Reauthorization bill asa stand- alone bill in Jane. Retaining the Woodall language is the foundation to addressing the major issues in air ambulance billing, Senate support of the Woodall language would preserve state authority to enact or enforce a Law or regulation that would gover network participation,reimbursement, balance billing, and price transparency for air ambulance operators providing. services In conjunction with the Tester Bill, the Woodall language has received nationwide support from the National Association of Insurance Commissioner, insurance carriers, hospitals, sir ambulance accreditors, EMS directors, consumer groups, and state insurance regulators. As the Commissioner of Insurance, protecting Mississippi residents from unreasonably high and ‘unregulated rates for emergency services is imperative, The Mississippi Insurance Department ‘would appreciate your suppor in this important matter. State of Mississippi Ce: The Honorable Phil Bryant ‘The Honorable Gregg Harper Governor State of Mississippi United States Congressman P.O. Box 139 307 Cannon Office Building Jackson, MS. 39205 Washington, D.C. 20515 ‘The Honorable Bennie G. Thompson ‘The Honorable Trent Kelly United States Congressman United States Congressman 2466 Raburn House Office Building 1427 Longworth Office Building ‘Washington, D.C. 20515 ‘Washington, D.C. 20510 ‘The Honorable Steven Palazzo United States Congressman, 331 Cannon Offiee Building ‘Washington, D.C. 20515