New Virginia Law Shines Light on Ambulance Billing Backlash


Driven by a larger nationwide discussion regarding balance or “surprise” billing, a new law enacted in Virginia and set to take effect in March of 2019 will force air ambulance providers to inform patients of their choices prior to the flight.

Virginia Senator Jeremy McPike (D) Senate District 29, first introduced the bill in January of this year. Showing both popularity and bi-partisan support, which as we know is rare these days, the bill sailed through both the Virginia House and Senate garnering unanimous votes in both chambers and moving to the Governor’s desk in just two months.

New Virginia Law Shines Light On Ambulance Billing Backlash


The bill requires a hospital to establish a protocol requiring the presentation of a written or electronic notice to a patient and/or his/her authorized representative of choice between air and ground transportation when the patient does not have an emergency medical condition.

The notice must inform the patient that he/she…

“…he/she may have a choice of transportation by an air medical transportation provider or medically appropriate ground transportation by an emergency medical services provider and…”

“…will be responsible for charges incurred for such transportation in the event that the provider is not a contracted network provider of the patient’s health insurance carrier or such charges are not otherwise covered in full or in part by the patient’s health insurance plan.”

Virginia OEMS tasked…

In addition to requiring the above notice to the patient, the bill tasks Virginia’s Department of Health’s Office of Emergency Medical Services to develop a mechanism to disclose a good faith estimate of the range of typical charges for out-of-network air transport services provided in that particular geographical area to the patient.

The estimate must be provided to the patient prior to the provision of services by any out-of-network air ambulance provider. Providing advance notice is a trending requirement as the overall balance billing discussion widens.

One Slice of the Pie

The Virginia law is but one slice of what the public labels “surprise” billing pie. Initiatives are growing across the United States, at the federal and state levels, fueled by shocked patients who one day open an envelope containing a stunning bill for the out-of-pocket portion due for their transport.

The patient complaints, while most noticeable in the air-ambulance industry due to the larger amounts billed versus ground ambulance, touch both air and ground ambulance transportation. It’s difficult for average citizens to wrap their brains (and their wallets) around the fact that they must write a check for sometimes multiple thousands of dollars. Then the backlash reaches the lawmakers’ ears as their constituencies reach out for legislative action for what they see as an intervention.


Ambulance industry advocacy groups- the largest of which are the Association of Air Medical Services (AAMS) and the American Ambulance Association (AAA), concede that transparency is a must. It is important that the industry demonstrates the need for billing charges that often fall outside of insurance coverage for the patient.

In reaction to public pressure, lawmakers at the state and national level are attempting to legislate balance billing to protect the patient. Unfortunately, many of the same lawmakers refuse to recognize that Medicare and Medicaid reimbursement rates fall severely below the costs incurred by the ambulance industry to provide our services. Add uninsured, self-pay patients and patients with high deductible insurance plans to the mix and the funding picture grows even more bleak.

Thus, in response, the ambulance industry- air and ground- must compensate by charging more in an attempt to offset the losses by collecting much needed dollars from those patients who are adequately insured and/or have the means and can afford to pay for the service they were provided.

Education is the Key

It’s important that the ambulance industry continue to educate both lawmakers and the public regarding funding challenges it faces on a daily basis because it’s just too easy to make us look like the bad guys in the space of a 3-minute news story.

The industry must be open about our finances and transparent regarding the decisions we make when pricing our services. It is also imperative that we explain the decision process when choosing to transport by ground versus air. It is important that we have conversations with the public so they grasp an understanding of the life-saving importance of the snap decisions we make.

If the public is informed, then lawmakers will also be informed by way of the ballot box. But it is equally important that the industry has continual, direct discussions with lawmakers so they fully understand that the ambulance industry in America is stressed financially. Lawmakers must grasp that much of that stress spills outward as we all try to maintain excellence in the services we provide, which we can only continue to do if we can pay the bills.

One thought on “New Virginia Law Shines Light on Ambulance Billing Backlash

  1. I guess I would not use the helicopter for transport unless there was an emergent need to get the patient to a higher level of care (STEMI, Stroke, Leaking Aneurysm, post cardiac arrest…)

    Both on the air and medical side if all the insurance companies would reimburse at a rate that covered the cost of providing the service (including the maint. and replacement of ambulance of aircraft) then the bills would not have to be so high.

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