WHY DO EMERGENCY AIR MEDICAL SERVICE MATTER TO ME?

Each year, hundreds of thousands of critically ill patients rely on emergency air medical services for lifesaving care. Because of this service, patients are able to reach the care and services they need for better outcomes. In rural parts of the country, emergency air medical transport and treatment by a critical care team is often the only access to life saving care in cases of emergency.

WHAT IS AN AIR AMBULANCE?

An Air Ambulance is a flying critical care unit equipped with state-of-the-art medical equipment, supplies, and clinical staff to ensure lifesaving care during an emergency. It is a crucial part of quality emergency medicine whether care and transport are needed at the scene of an accident or at a hospital. These highly equipped airplanes and helicopters come with uniquely skilled crews and are called on as tools when a critically ill or injured patient needs to be taken to sometime distant facilities for specialized diagnostic or treatment capabilites. Our family and neighbors rely on emergency air medical services for access to trauma, cardiac, burn, stroke, tertiary care and neonatal within the critical “golden hour” of the patient’s event. This hour is defined the first hour after the occurrence of a traumatic injury, considered the most critical for successful emergency treatment.

WHAT DOES APOLLO MEDFLIGHT DO FOR ME?

Primarily, we transport you in our state-of-the-art aircraft with our critical care team, but our patient advocacy team continues working with you after the transport to find all potential sources of payment to decrease your responsibility, including your health insurance plan. We will communicate with you throughout the process to make sure you are informed. Once the insurance billing process is finalized, we will contact you to discuss the multiple ways to resolve any outstanding balance.

WHY AM I RECEIVING A BILL FROM APOLLO MEDFLIGHT IF I WAS TRANSPORTED BY AN AIR AMBULANCE WITH A DIFFERENT NAME?

Apollo MedFlight provides lifesaving emergency care across the United States, operating with partners having other locally known program names.

WHY AM I GETTING SEPARATE BILLS FROM APOLLO MEDFLIGHT AND THE HOSPITAL?

Rather than have their own air medical aircraft, hospitals sometimes partner with a highly specialized provider such as Apollo MedFlight, to provide air ambulance services. Because Apollo MedFlight is not part of the hospital and operates as a separate entity, it is not possible to combine the bills.

Emergency air ambulance transport and treatment are among the many crucial medical services where health insurers are seeking to limit, deny, or delay payments.

The main purpose of health insurance is to protect patients like you in emergency situations like the one you faced. But increasingly, insurance companies paying less and less of their members’ medical costs. This means patients are left exposed to balances the health insurance company should be paying. It is our commitment and intent to work side-by-side with insurers, healthcare providers, and patients to create a system that works for everyone.

When it comes to obtaining payment for their service, Apollo MedFlight works with insurance companies to ensure adequate coverage for their members. When adequate coverage is not provided, we are required by law to pursue uncollected balances to help cover the cost. In these situations, we work very closely with patients to minimize their out-of-pocket expenses and your patient advocate will be there every step of the way.

If patients do not have insurance, please know that there may be other available sources of financial assistance available. Apollo MedFlight has a long-standing financial aid assistance program and is committed to working with patients based on their individual financial circumstances.

We are in network with many insurance plans, and will work together with them to leave you owing no more than your deductibles and co-insurance. If we are not in network with your plan, you may be left with a balance, but we will work with you to make sure your insurance pays according to your policy.

You will receive an invoice if we cannot locate your insurance information to bill them, if your insurance underpays, or you do not have insurance. A patient advocate will be reaching out to you to help. If you got an invoice in the mail, please call the number on it, and your patient advocate will educate you as to why you received it, and what can be done about it. We are experts in our field and are committed to assisting you. Our service does not end at the hospital we delivered you to.

Apollo Medflight is contracted with several insurance companies; however, this does not guarantee that your plan will process your claim correctly per your policy.

Here are some of the reasons why your plan may not cover the cost of your bill:

MEDICAL NECESSITY

Your plan has decided that your life-saving flight was not medically necessary and you could have been transported in a ground ambulance.

POLICY LIMITATIONS

Your plan may have benefit limitations regarding Air Ambulance services.

UNDERPAYMENTS

Your plan paid but it did not pay correctly per your policy and has left the remaining balance to you.

NETWORK

If Apollo Medflight is not contracted with your plan, they will process your claim out of network leaving you a higher patient responsibility.

Whatever the reason your plan has not covered the cost of your bill, Apollo Medflight will work with you to ensure your plan pays the maximum your benefits will allow before seeking funds from you.

At Apollo MedFlight, we understand that excellent patient care does not end with the transport. The financial costs related to emergency care are often overwhelming, and we continue to support our patients throughout every step of the billing process.

We have Financial Assistance options and special discounts available to help alleviate your worries. If you receive a bill that is beyond your ability, please allow us to help you. Contact your Advocate today.

ALLOWABLE AMOUNT The allowed amount is the amount your insurance carrier is willing to pay for a rendered service. This can be from a sampled average of charges for the service, derived from a fee schedule, an amount that other providers have agreed to accept for the same service, or the rates used by Medicare for the service. These vary from Payor to Payor and are not always consistent with the rates we are quoted during the eligibility process. Differences between this amount and billed charges can result in balance bills if we are not in-network with the Insurance. Not to worry! If this happens to you, your Patient Advocate will be there to help you navigate the processes to fix it.

APPEAL A request for your health insurance company or the Health Insurance Marketplace to review a decision that denies a benefit or payment. It is also used to appeal underpayments. Most insurers allow appeals from both providers and Member appeals. Some payors may require a Designation of Representation form signed by the member before Apollo is allowed to appeal. A form provided by the Insurance company is usually required with these requests.

ASSIGNMENT OF BENEFITS (AOB) Allows provider to bill, appeal, and act as your representative to secure payment from your insurance.

BODILY INJURY (BI) COVERAGE A type of insurance that is attached to car insurance and pays for physical harm in the event of an accident. This does not cover medical expenses for the driver, but it does cover medical expenses for passengers and the other driver who was hit.

CLAIM A request for payment that you or your health care provider submits to your health insurer when you get items or services you think are covered.

COINSURANCE A form of medical cost sharing in a health insurance plan that requires an insured person to pay a stated percentage of medical expenses after the deductible amount, if any, was paid.

COORDINATION OF BENEFITS (COB) This is a form sometimes required by your Insurance before the processing of a claim. The primary intentions of coordination of benefits are to make sure that individuals who receive coverage from two or more plans will receive their complete benefit entitlement and to prevent benefits from being duplicated when an individual has more than one policy in place. This process covers insurance pertaining to several sectors including health insurance, car insurance, retirement benefits, workers compensation, and others. If you have been asked to provide this, your claim may not be processed without it. Please call your Patient Advocate for assistance.

COPAYMENT (COPAY) A form of medical cost-sharing in a health insurance plan that requires an insured person to pay a fixed dollar amount when a medical service is received. The insured is responsible for the rest of the reimbursement.

DEDUCTIBLE A fixed dollar amount during the benefit period, usually a year, that an insured person pays before the insurer starts to make payments for covered medical services. Plans may have both individual and family deductibles.

DEPARTMENT OF INSURANCE Regulates insurers and other companies that conduct insurance business and assists insurance consumers. Each state has its own. This is a state regulatory body and complaints can be filed against Insurance plans. These typically apply to Fully Funded insurance plans. Please call your Patient Advocate, they can educate and assist you with this.

DENIAL When the insurance states they will not process your claim, will not pay the claim, or underpays the claim. Contact your Patient Advocate for the tools and steps to help us overturn this with you.

DESIGNATION OF REPRESENTATION (DOR) Allows you to designate an individual to represent you on a specific appealed claim.

EVIDENCE OF COVERAGE (PLAN DOCUMENTS) Your contract with the insurance company that explains your policy coverage in detail. These are extremely important when attempting to overturn a payment or coverage

decision by your Insurance. Most of the time they can be accessed online by logging into your member portal on the Insurance Website.

EXPLANATION OF BENEFITS (EOB) A statement sent by your health insurance company to covered individuals explaining what services were paid for on their behalf.

EXTERNAL REVIEW This is a state-mandated option to assure that a person covered by a health benefit plan has the opportunity for an independent review of an insurance company’s determination for a service for which the individual filed a benefits claim that did not meet an insurance company’s requirements for medical necessity, appropriateness, health care setting, level of care, or effectiveness and that as a result, the requested payment for the service was denied, reduced, or terminated by the insurance company. These are preceded by the normal Insurance company appeal processes.

FULLY FUNDED A fully funded plan is a health plan that is sponsored by an insurance company rather than an employer. That means a health insurance carrier holds your insurance policy and assumes all of the risk. Your employer simply pays the premiums for your group coverage. Health Marketplace Exchange Individual policies fall into this category as well.

HIPAA NOTICE (NOTICE OF PRIVACY PRACTICES) Explains how your medical information can be used or disclosed and how you can get access to this information.

HOME PLAN If you have an insurance plan that originates in a specific region or state, and you receive covered services from a medical provider in a different location, the claim will be filed in the state the service occurred. The insurance where we filed the claim is referred to as the “local”, and the state the policy is originating from is referred to as the “Home Plan”. This is primarily a designation that applies to Blue Cross and Blue Shield franchises across the different states.

INSURANCE QUESTIONNAIRE Used to provide all insurance information to the provider.

LOCAL If you have an insurance plan that originates in a specific region or state, and you receive covered services from a medical provider in a different location, the claim will be filed in the state the service occurred. The insurance where we filed the claim is referred to as the “local”, and the state the policy actually originating from is referred to as the “Home Plan”. This is primarily a designation that applies to Blue Cross and Blue Shield Franchises across the different states.

MEDICAL RECORDS The records that we create and retain in relation to your transport with us. These are given to the Insurance company when a claim is filed by us.

MEDICAL NECESSITY This is the criteria set in place by insurance guidelines and the Centers for Medicare and Medicaid Services to determine if a service is needed by clinical definition and diagnosis code. If a reviewer believes the patient could have been transported by a ground ambulance or did not need the service based upon the clinical documentation, they may deny the claim. If this happens, we will follow the procedures to appeal. If this happens with your claim, please contact your Patient Advocate and we will do everything possible to help you overturn it.

MED-P A Y Refers to medical payment coverage, optional insurance coverage that is offered as a part of your auto insurance policy.

OUT-OF-POCKET-MAXIMUM (OPM) The most a health insurance policyholder will pay each year for covered healthcare expenses. It is also called the out-of-pocket limit.

PERSONAL INJURY PROTECTION (PIP) Personal injury protection (PIP), also known as “no-fault insurance,” is a component of an automobile insurance plan that covers the healthcare expenses associated with a car accident. PIP covers medical expenses for both injured policyholders and passengers, even if some don’t have health insurance.

PLAN DOCUMENTS (EVIDENCE OF COVERAGE) Your contract with the Insurance company that explains your policy coverage in detail. These are extremely important when attempting to overturn a payment or coverage decision by your Insurance. Most of the time they can be accessed online by logging into your member portal on the Insurance Website.

REFERENCE NUMBER Unique number used to retrieve your account information. It is important to record these, as the Insurance company can look at previous conversations you have had with their representatives. These can be helpful to provide to Apollo when they are advocating for you.

SELF-FUNDED The employer assumes the financial risk for providing health care benefits to its employees. In practical terms, Self-Insured employers pay for claims out-of-pocket as they are presented instead of paying a pre-determined premium to an insurance carrier for a Fully Insured plan.

SHORT PAY An underpayment by the insurance company, which is smaller than the amount quoted during the Eligibility Process.

STOP-LOSS Also known as re-insurance. This is an insurance product for self-funded plans that protects against catastrophic or unpredictable losses. It is purchased by employers who have decided to self-fund their employee benefit plans but do not want to assume 100% of the liability for losses arising from the plans. Under a stop-loss policy, the re-insurance company becomes liable for losses that exceed certain limits called deductibles.

THIRD-PARTY LIABILITY (TPL) Refers to insurance that provides protection against liability caused by accidental injury or death of other persons. Examples of liability insurance are homeowner’s insurance, uninsured and underinsured motorist insurance, bodily injury protection, casualty and umbrella policies, wrongful death benefits, or professional liability.

UNINSURED MOTORIST COVERAGE A provision commonly found in the United States automobile insurance policies that provide for a driver to receive damages for any injury he or she receives from an uninsured, negligent driver.