<figure>
 <img src="https://media.eaglewebservices.com/public/2020/5/1590675173475.png" alt="Crysta Henthorne / KCUR" />
 <figcaption>Crysta Henthorne / KCUR</figcaption>
 </figure><h2>States have tried for years to tackle the skyrocketing price of air ambulances</h2>BY CELIS LLOPIS-JEPSEN <a href="https://www.kcur.org/news/2020-05-27/kansas-supreme-court-mulling-whether-the-state-can-police-medical-bills-from-air-pirates">Kansas News Service</a>TOPEKA — Fed-up with sticker shock from air ambulance bills, one insurer has pressed its case all the way to the Kansas Supreme Court.A justice on the state’s high court seemed sympathetic, even as he 
questioned whether state courts hold the power to tackle practices that 
critics see as predatory.“We understand that you’re trying to 
fight federally sanctioned air pirates,” Justice Dan Biles told an 
attorney for the insurance company during <a href="https://www.youtube.com/embed/FR0p04ZRA0U?autoplay=1&amp;rel=0" target="_blank">oral arguments</a> in Topeka in January. “But … it seems like your fight is with Congress.”<figure>
 <img src="https://media.eaglewebservices.com/public/2020/5/1590675381919.png" alt="" />
 <figcaption></figcaption>
 </figure>The Kansas Supreme Court has yet to rule in <a href="https://www.kscourts.org/KSCourts/media/KsCourts/Opinions/117903.pdf?ext=.pdf" target="_blank">the case</a>. It involves <a href="http://www.flyeaglemed.com/" target="_blank">EagleMed</a>,
 a company that billed Travelers Insurance tens of thousands of dollars 
in 2013 for each of four people flown from rural areas to hospitals in 
Wichita and Garden City.The insurer balked at the bills and offered far lower payouts based on Medicare rates.Massive
 bills for air ambulance rides are common. The Kansas News Service wrote
 this week about Alvin Letner, a retired school teacher facing <a href="https://www.kcur.org/news/2020-05-26/a-kansans-50k-medical-bill-shows-that-you-dont-always-owe-what-youre-charged" target="_blank">a nearly $50,000 bill</a> for a 30-mile transport following a traffic accident.<figure>
 <img src="https://media.eaglewebservices.com/public/2020/5/1590675306655.png" alt="" />
 <figcaption></figcaption>
 </figure>Such bills are notoriously tricky for states to rein in, because 
federal law shields air ambulance companies from many of their attempts 
at regulation. Because the EagleMed case involved injured workers, 
however, the insurer hoped that would give Kansas authority to review 
EagleMed’s charges.The Kansas Division of Workers’ Compensation sets pay rates for other medical services stemming from workplace injuries.In <a href="https://www.ca10.uscourts.gov/opinions/16/16-8064.pdf" target="_blank">a similar case from Wyoming</a>, the U.S. 10th Circuit Court of Appeals ruled in 2017 that states couldn’t set rates.Wyoming
 had limited its workers’ compensation fund to paying out $3,900 for 
transporting an injured worker by helicopter (plus a modest mileage 
fee).Air ambulance operators sued, and federal judges agreed that
 Wyoming couldn’t set that price. Why? Because medical helicopters and 
planes fall under the same 1978 federal aviation law that regulates 
airlines and prevents states from setting airline prices.Kansas 
is one of at least two states where supreme courts are considering 
similar cases. In the Kansas case, Travelers Insurance argues the state 
can review air ambulance charges without actually setting their rates 
the way Wyoming had done.The other pending case is in <a href="http://www.search.txcourts.gov/Case.aspx?cn=18-0216&amp;coa=cossup" target="_blank">Texas</a>.In 2015, <a href="https://www.tdi.texas.gov/medcases/soah15/454-15-0681.M4(R).pdf" target="_blank">an administrative judge</a> there concluded he could weigh
 in on prices. He pegged the fair payout for air ambulances in workers’ 
compensation cases at about 1.5 times Medicare rates. That, he said, 
ensured the helicopter company “a reasonable profit.”Outrage at air ambulance prices is fueled in part by dramatic increases. <a href="https://www.gao.gov/assets/700/697684.pdf" target="_blank">Federal investigators</a> compared 2010 and 2014 prices and found they had doubled.Those investigators also found that air ambulances aren’t subject to the same type of <a href="https://www.gao.gov/assets/690/686167.pdf" target="_blank">price competition</a> as airlines.A
 person unconscious after a traffic accident can’t call around for price
 quotes or ask emergency responders to find an air ambulance within 
their insurance network.Air ambulance companies, meanwhile, argue that higher prices for some privately insured customers help balance out <a href="https://www.xcenda.com/news-and-events/news/0417_air-medical-services-costs" target="_blank">lower payments</a> for serving people on Medicare, Medicaid or without insurance.Some companies also argue that a sharp increase in air ambulances <a href="https://www.gao.gov/assets/690/686167.pdf" target="_blank">vying for patients</a> has cut into each chopper’s workload, making it harder to maintain profit margins.Still, the growing chorus of complaints over hefty bills has prompted Congress to create <a href="https://www.transportation.gov/airconsumer/AAPB" target="_blank">a special committee</a> that’s looking into the problem. That body met for the first time in January.Celia Llopis-Jepsen reports on consumer health and education for the Kansas News Service. You can follow her on Twitter <a href="https://twitter.com/Celia_LJ" target="_blank">@celia_LJ</a>
 or email her at celia@kcur.org. The Kansas News Service is a
 collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public
 Radio focused on health, the social determinants of health and their 
connection to public policy.

High court mulling if state can police medical bills from 'air pirates'