Dr. John Hey introduced the following resolution at the 2016 Mississippi State Medical Association annual convention in Jackson, Mississippi.

Resolution concerning aero-medical ambulance services

Mississippi State Medical Association

House of Delegates

July 21, 2016

WHEREAS: the emergency services and trauma network infrastructure has been gradually rebuilding since our victory in tort reform removed that most destructive of forces in caring for our patients; and

WHEREAS: Mississippi has been very fortunate to have a superb ambulance service with well-trained EMTs, and emergency departments in most hospitals staffed by highly competent physicians; and

WHEREAS: we are all aware of the “golden hour,” and the necessity to get severely endangered patients to the appropriate area of treatment quickly; and

WHEREAS: many ground ambulance services also own helicopters for air evac, but these companies have had financial difficulties due to the high fixed cost of helicopters, coupled with the low volume of patients they could transport; and

WHEREAS: large out-of-state corporations began to buy up these air ambulance services and took over providing this service in large areas of our state; and

WHEREAS: these large corporations have exploited a loophole in federal aviation laws which bars local and state agencies from calling into question their charges to patients for providing air ambulance services; and

WHEREAS: these corporations have eschewed the regular provider networks of our state’s major insurance carriers, giving them the ability to charge exorbitant prices to our patients for aero-medical transport; and

WHEREAS: these predatory pricing schemes have left many patients owing $50,000 to $100,000 for a trip to the emergency room in Jackson or Memphis; and

WHEREAS: most of our insurance carriers in Mississippi will allow $5000 to $10,000 as a fair market price for these services; and

WHEREAS: ethical air ambulance services accept the fair market price allowed by the patient’s insurance carrier, leaving the patient only to pay the co-pay.  One such service is offered by the University of Mississippi Medical Center; and

WHEREAS: Several out-of-state air ambulance companies, on the other hand, do not honor the fair market price approved by the insurance carriers, demanding payment in full from the patient even after receiving reasonable payment by the insurance carrier; and

WHEREAS: these predatory pricing and collection practices force many of our patients into bankruptcy, and subject them to heavy-handed collection practices and threats of lawsuits; and

WHEREAS: while some of these companies attempt to justify their outrageous charges because they claim that they would suffer financial loss due to low pay rates from Medicare, Medicaid, and no-pay patients, a review of these corporations’ financial statements shows that, in reality, they are netting billions of dollars each year in profits from providing these services; and

WHEREAS: One of the purposes of the Mississippi State Medical Association is to ensure quality care for our patients, and to protect them from predatory practices that would harm them along with our medical system.

Therefore, be it resolved by the House of Delegates:

  1. That this body create a task force to develop guidelines and principles to be used by emergency medical personnel to determine the appropriateness of air evacuation in particular cases, and to promulgate such guidelines to all relevant parties for implementation;
  2. That this body designate experts to determine what is a fair market price for air ambulance services in our state;
  3. That this body designate staffing to compile typical fees charged by all air ambulance services that operate in our state, along with information showing, from their financial statements, annual profits made for providing such services, in order to refute their claims that low reimbursements force them to charge such exorbitant rates;
  4. That this body direct its staff to provide to all emergency departments in our state a list of air ambulance services, regardless of their membership in insurance provider networks, indicating their average fees charged, and whether or not each one accepts insurance carriers’ usual and customary pricing as the basis for their billing;
  5. That this body, and its executive staff, encourage our Congressional delegation to sponsor and shepherd to passage a bill to remove aero-medical ambulance services out from under the airline deregulation bills that were passed decades ago;
  6. That this body direct its executive staff to begin efforts to have our state legislature adopt a statute requiring that all air ambulance services that accept assignment of insurance benefits and receive insurance payments for their services thereby be bound to accept the usual and customary price set by the insurance carrier as full satisfaction for the services they rendered;
  7. That this body direct its legal staff to prepare and disseminate legal strategies for aggrieved patients and their private attorneys as to how to protect themselves from predatory billing practices by the air ambulance companies;
  8. That this body direct its legal staff to develop a regulation, to be promulgated by state regulatory bodies, that requires ground ambulance services to deliver patients to the nearest emergency medical facility with a physician on duty, and prohibits such ground ambulance services from delivering patients directly into the hands of an air ambulance service without prior authorization by said emergency physician.