US Supreme Court Will Not Review Air Ambulance Billing Issue

The US Supreme Court  (SCOTUS) will not review the pre-emption issue involving air ambulance billing charges. A Petition for Certiorari that was denied was filed by PHI Air Medical, LLC following the denial of the Texas Supreme Court to honor the full air ambulance billing changes in a workers’ compensation claim.

Medical benefits are a significant factor in the overall costs of most state workers' compensation programs. The ability to contain those costs is at the very heart of the viability of most workers’ compensation systems. Federal preemption of state medical fee schedules and regulations is a prevailing challenge to the patchwork of non-uniform state benefit programs.

QUESTIONS PRESENTED

The Airline Deregulation Act of 1978 (“ADA”) broadly preempts any state law or regulation “related to a price, route, or service of an air carrier.” 49 U.S.C. §41713(b)(1). Air-ambulance companies are federally licensed “air carriers.” Nonetheless, the Texas Workers’ Compensation Act dictates the amounts air-ambulance companies may charge and collect for air-transport services provided to individuals covered by workers’ compensation. Specifically, workers’ compensation insurers need only pay a “fair and reasonable” rate—calculated here to be 125% of the Medicare rate—and air-ambulance companies are forbidden from billing patients or their employers for the service. Given that such schemes dictate what the only party that can be charged must pay to air carriers, the Fourth, Tenth, and Eleventh Circuits have held that comparable state laws constitute impermissible rate regulation preempted by the ADA, but a divided Texas Supreme Court upheld the Texas system at issue here.

The questions presented were:

1. Whether the ADA preempts a state workers’ compensation system that limits the prices an air-ambulance company can charge and collect for its air-transport services.
2. Whether the McCarran-Ferguson Act exempts such a system from ADA preemption.

PHI Air Medical, LLC, Petitioner v. Texas Mutual Insurance Company, et al., US, Docket No. 20-748., Cert. denied,, ___ S.Ct.____, 2021 WL 1602647 (2021).

Guidelines for Medical Provider Claims - A Valuable Approach

While the vast majority of jurisdictions in the US have the guidance of mandatory workers' compensation medical fee schedules, New Jersey remains one of the very few with no such structure. As I reported earlier, this generates multiple issues in the claims process and creates costly delays in the adjudication of disputes.

The Consequences of TrumpMedical 2016–25: Price Increases, Aging Push Sector To 20 Percent Of Economy

Workers' Compensation medical expenses mirror some of the national health care projections. An aging workforce and the increased longevity of the population impacts overall all costs. Furthermore as the Affordable Healthcare Act's repeal has been anticipated by the Republican Administration, medical care costs are anticipated to spiral. The draft release of the Republican proposal for a new national medical care system is now being revealed.

Directly and indirectly, workers' compensation coverage will feel the impact. For chronic condition denials, pre-existing condition denials and occupational disease denials, the safety net of Medicaid will be diminished and the workers' compensation system will again be the primary target for payment and litigation will increase logarithmically.

Who Is Paying the Bills for Occupational Illnesses and Disease?

A recently published study from the US Department of Health and Human Services (NIOSH) reports that 45% of emergency room medical expenses for occupational illnesses and disease are not expected to be paid by workers' compensation insurance coverage.

Click here to read the complete report: Use of Workers’ Compensation Data for Occupational Safety  and Health: Proceedings from  June 2012 Workshop (May 2013) Identifying Workers’ Compensation as the Expected Payer in  Emergency Department Medical Records,  Larry L. Jackson, PhD, Susan J. Derk, MA, Suzanne M. Marsh, MPA, Audrey A. Reichard, OTR, MPH  National Institute for Occupational Safety and Health