In the model, NCOIL:
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Requires a health plan without an "adequate network" of air ambulance service providers to provide a reimbursement rate equal to the state's average.
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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.
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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.
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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.
