LifeNet claims the qualifying payment amount is still being applied to air ambulances despite a recent ruling over the regulation's billing resolution process.
The Texas-based company is the latest to file a lawsuit against the Department of Health and Human Services (HHS) over the rule, which protects patients from surprise bills when getting treatment from out-of-network providers.
LifeNet claims HHS is still applying the QPA to air ambulance providers despite the Eastern District of Texas federal court recently ruling with the Texas Medical Association (TMA) in a lawsuit against the rule's independent dispute resolution (IDR) process.
The IDR process allows providers to require minimum payment for services from the patient's insurer based on the QPA, which is the median in-network rate. However, the TMA and other providers have argued that the QPA is presumptive and unfairly caps the amount they can charge.
Though that part of the rule was struck down in the TMA lawsuit, LifeNet claims air ambulance providers are still being held to the same requirement and asks the court to vacate that part as it did in the previous case.
"Applying the QPA presumption only to air ambulance IDRs is arbitrary, irrational, and deviates from the statute," the lawsuit states. "The statutory text indicates that the QPA should be used in the same way in air ambulance IDRs as in all other IDRs, i.e., as one factor among many to be considered."
LifeNet operates from three airbases and transports patients in Texas, Arkansas, and Louisiana, according to the lawsuit. It claims it operated many emergency flights as an out-of-network provider transporting patients who were insured by a commercial health plan or insurer in 2021 and will continue to do so this year.
Air ambulance charges are known to be notoriously high and costly for patients who are short of options in emergencies. According to a study by Health Affairs, air ambulance charges were four to 10 times higher than what Medicare paid for the same services in 2016. The median charge ratios for the services increased by 46% to 61% from 2012-16.
The American Hospital Association has supported "addressing air ambulances in a federal solution to end surprise medical bills, but has serious concerns with using a benchmark rate to resolve payments between health plans and out-of-network providers."
Jay Asser is the contributing editor for strategy at HealthLeaders.