Offering Employees Protection Against Rising Medical Transportation Costs

By Shaun Walti, MASA Medical Transport Solutions

Imagine you are traveling on a well-earned but long overdue family vacation A lot of time went into planning for this once-in-a-lifetime experience with the whole family, and the first few days have been amazing Then you notice that you didn’t wake up feeling as refreshed as you might expect You chalk it up as a little jet lag catching up with you and remind yourself that you’re on vacation, and when is there ever a better excuse for a nap and no better day than today!By that afternoon, that not so good feeling has worsened, and what really grabs your attention is a feeling of uneasiness and pressure in your chest.

Better to be safe than sorry, so let’s get this checked out. The first stop for this unplanned family field trip is an urgent care clinic not too far from where you are staying. It is then that one of your worse fears is seemingly coming true when the initial workup done confirms a potential cardiac event, but this clinic is not equipped nor staffed to handle the level of care that you need So, the staff calls 911, and an ambulance arrives shortly thereafter You are taken to the nearest hospital for additional tests and radiological imaging The good news is that you made the right decision to get checked and caught this early, the bad news is that you need advanced care only a specialized cardiac unit can provide, and, unfortunately, this hospital does not have what you need

So, after you’ve been stabilized, another ambulance is dispatched to transport you to a more advanced facility, and you’re admitted You’ve also been prioritized for an angiogram first thing in the morning where you received two stents and are held for additional treatment, observation, and recovery, a recovery that spans beyond the remainder of your planned vacation days If you wish to be close to home for the remainder of your recovery, you will need a specially equipped and staffed aircraft to do so safely, and you choose to proceed with getting yourself to a facility where your family and friends can visit which only improves your recovery.

This chain of events may sound like an outlier, but it is not unusual for an initial transport to result in one or more subsequent transports. There are many reasons for this, it could be due to the patient requiring a higher level of care, or maybe the scene of an accident does not have a safe area nearby for a helicopter to land thus requiring a ground transport to deliver the patient to a safer zone In fact, the transport journey I just took you through is very similar to an actual claim where MASA Medical Transport Solutions covered the member’s outof-pocket costs associated with all three transports: 1) his initial ground transport from the urgent care to the first hospital, 2) his subsequent ground transport to the second hospital, and 3) his repatriation transport to a facility near his home A sequence of events that could have cost him a pretty penny if not for having a medical transportation benefit in place

So, how significant is this problem? Let’s look at the impact on medical transportation frequency and costs in the US

In terms of frequency, according to the National Association of State EMS Officials in 2022, there are roughly 28 million emergency transports dispatched by 911 every year. When broken down by type, this trend translates to approximately 1 ground transport for every second of each day and 1 air transport for every minute of each day. As the U.S. population grows and ages, that trend looks to only increase over time.

Regarding costs, the National Association of Insurance Commissioners in 2022 determined the average full billed amounts to be $40,000 for helicopter ambulance and $1,500 for ground ambulance HealthCare Insider in 2021 stated that “employees may be responsible for total full billed ambulance charges if their claim is denied” Add to this data, the industry has seen a demonstrative increase in costs for several reasons with increased fuel and supply costs playing a key role

Now, the No Surprises Act, which went into effect in January 2022, has provided protections for patients against “surprise” balance bills. However, this legislation only addresses air transportation claims which represent just about 2% of the problem. The vast majority of claims every year are for ground transports, and, in most states, the No Surprises Act does not include protections for this type of ambulance service.

So, what are the ways that folks get hit with these costs? First and foremost, regardless of how a patient is transported, the employee will likely be on the hook for their coinsurance and deductible as defined by their medical plan since medical transports often result in first-dollar deductible exposure There is also a potential for ground transport balance bills producing an additive effect on the overall amount that employees must come up with to settle their claims Consumer Reports touched on this in 2021 where it was found that “79% of all ground ambulance rides could result in an out-of-network bill,” which is not surprising as there are over 21,000 ground providers and roughly 300 air providers overlapping one another in coverage areas across the U.S. Lastly, some transport claims, such as inter-facility, non-emergent, or repatriation, may be deemed not medically necessary and denied by the medical plan, placing the entire cost burden squarely on the employees’ shoulders.

When considering the prevalence and financial impact to families, it is plain to see that significant risk exists, and it is warranted to offer a Medical Transportation Benefit to protect employees from these sizeable and unplanned expenses Truly, a legitimate case can be made that the proven reasons for offering employees solutions such as Critical Illness or Hospital Indemnity plans are the very same reasons to offer a Medical Transportation Benefit Doing so would be an enhancement to the overall employee benefits program strategy, and it would not only add much needed coverage for employees but also provide protection against a medical transport claim potentially eroding the benefit amounts paid by other voluntary benefits in place

Take for instance, a Critical Illness policy with a $10,000 face amount for an employee with a $4,000 CDHP in the beginning of the plan year. Likely, this employee has not yet met much, if any, of their deductible limit and unfortunately experiences a heart attack for which they require medical transportation. As most transports result in first-dollar deductible claims, along with the additional claims associated (hospital admission, treatments, and procedures, etc.) that $10,000 face amount really only nets out to a $6,000 benefit, and then, if that ground transport provider balance-bills the patient, further erosion of the CI benefit occurs What if that employee requires some time off work to recover and needs extra funds for rent or other bills? Or, what if the employee was traveling when this occurred and wishes to be repatriated to a home facility? Or, worse yet, what if that critical illness event results in a lasting disability requiring a home modification to accommodate the employee’s “new normal?” These are all possible scenarios where a surplus of the CI benefit would be a much-needed saving grace, and having a Medical Transportation Benefit in place would at least protect against the ambulance costs

Another important factor to consider is how this plays out with the employer As with the traditional cause and effect of employees’ financial stresses leading to deleterious effects at work, surprise expenses due to medical transportation are no different. The effects are many: decline in overall wellbeing and employee morale, decreased productivity, increased absenteeism, reduced employee engagement and risk of increased turnover. The added stress could even lead to further poor medical outcomes for some employees leading to more cost burden to the medical plan

It’s safe to say that there’s enough skin in the game for both parties here to necessitate evaluation and offering a solution

In terms of the discovery process, it is worth discussing the impact of medical transport costs with every group client When evaluating this cost, it is important to ensure all data sets are considered One might not realize that there are several HCPCS codes to include when reviewing claims reports In fact, MASA Medical Transport Solutions comes across almost 30 common codes when processing claims for our members Some analysis might find that a group’s medical plan is so rich in coverage that there isn’t much exposure to the employee. However, in most cases, substantial risk will be identified.

Though working through this discovery is valuable for every client, there are some industry verticals where those clients’ decision makers will already have a keen understanding of the need for medical transport risk mitigation Public Sector, for instance, is acutely aware of the EMS and 911 budgeting strain experienced in efforts to ensure their communities are well served with desirable response times

State and local officials appreciate the value of a private sector payer in place to ensure solvency of their municipal funds. Hospital clients, often the providers delivering the medical transport needs to their communities, are very well versed in the process of collecting on those transport claims from their patients, and, in many cases, these claims are considered “bad debt.” Schools and Education clients employees find value as well where, often, they take advantage of the breaks in the school calendar for travel, and a Medical Transportation Benefit would provide the peace of mind they need There are many other sectors such as transportation and logistics companies, companies in rural settings or with remote employees, and companies where travel is a key component of doing business

As we all know, group clients will continue to challenge us to find and deliver new and unique ways to improve their benefits programs and protect their employees These benefit enhancements are at the core of their talent recruitment and retainment efforts, and Medical Transportation Benefits are a unique and fairly new entrant to the group space For many years, memberships have been offered by transport providers and a few payers on the individual market, but, in recent years, a payer solution offering a relatively novel and new employee benefit approach has emerged, and there’s no better time than right now to strike up the conversation and determine if a medical transportation benefit solution could be just what your client is looking for!

As someone who is a long-distance caregiver for my mother, regularly traveling from California to Michigan, there was a number that jumped out at me from a recent AARP report “Valuing the Invaluable: 2023 Update” The number that troubles me is 36 billion, because that’s the estimated number of hours of care that family caregivers performed in 2021 That is a staggering data point but one that includes my own experience with an aging parent. You may not be a caregiver now, but it will likely impact your future, or the future of a friend or a loved one. Being aware of the problem is the first step. Finding workable solutions is the more difficult part.

AARP Public Policy Institute has provided an updated analysis of the current state of family caregiving in the United States, highlighting the challenges and opportunities for supporting this vital workforce Family caregivers are individuals who provide unpaid care to a relative, friend, or neighbor who needs assistance with daily activities or health care They are essential for the well-being of millions of older adults and people with disabilities, as well as for the sustainability of the long-term services and supports (LTSS) system