AVALON — For residents, boaters, and visitors to Catalina Island, the specter of emergency medical airlifts has long been accompanied by the potential for daunting financial burdens. However, a significant shift in healthcare regulations has dramatically altered this landscape, providing crucial protection against unexpected costs. Catalina Island Health (CIH) is now emphasizing the importance of the No Surprises Act, a federal regulation that safeguards patients from exorbitant balance bills and surprise charges related to emergency medical care, including air ambulance transport.
Historically, air medical memberships were a common consideration for those on Catalina, anticipating the possibility of emergency transport to mainland hospitals via services like Mercy Air. The cost of such transport could be substantial, particularly in situations where Catalina Island Health’s facilities couldn’t provide the necessary care. However, since January 1, 2022, the No Surprises Act has effectively transformed this financial landscape for insured patients.
“The No Surprises Act didn’t change the way we handle emergency situations at CIH,” stated Jason Paret in response to The Log’s question about the Act’s impact on Catalina Island residents and visitors. He clarified, “The key provision of it is balance billing or surprise medical bills. We bill for both the physician and the hospital at CIH. This is to ensure that there is uniformity in the billing practice as we attempt to lower the amount of confusion regarding medical billing. Medical billing is confusing enough that having bills come from separate entities only complicates the matter. Also, it hasn’t been our practice to balance bill patients for charges that the out-of-network insurance provider will not cover.” Paret further emphasized, “In addition to emergency services, we provide price transparency on our website as is required by law,” referring to the PARA Price Transparency Tool. “To help our residents and visitors we have a robust financial aid program,” he added, directing readers to their website, which includes information on payment plans and discounted prompt pay policies, with “discounts or bill forgiveness based on income qualifications.” Paret concluded by highlighting CIH’s commitment to patient experience, noting, “for the third year in a row, our emergency department and clinic were awarded the Human Experience (HX) Guardian of Excellence Awards by Press Ganey.”
“The No Surprises Act protects patients from large balance bills and surprise costs related to emergency medical care – including air ambulance transport,” CIH officials stated in a news release. “That means an insured patient is only responsible for their deductible, co-pay or coinsurance, just as it would be with any other healthcare service.” This protection applies regardless of the insurance provider or whether the patient is considered in-network or out-of-network. The act effectively eliminates the risk of “surprise” or “balance billing” for emergency air transport, rendering air medical memberships largely obsolete for insured individuals.
Under the No Surprises Act, several key protections are in place:
- In-Network Cost-Sharing: Even when utilizing out-of-network providers, patients are only required to pay their normal in-network cost-sharing amounts.
- Direct Payment to Providers: Health plans are mandated to pay out-of-network providers and facilities directly.
- Emergency Service Coverage: Health plans must cover emergency services without requiring prior authorization, and they must cover out-of-network emergency services.
- Cost-Sharing Calculation: Patient cost-sharing is based on what they would pay an in-network provider, and this amount must be clearly stated in the explanation of benefits.
- Deductible and Out-of-Pocket Limits: Any amounts paid for emergency or out-of-network services count toward the patient’s deductible and out-of-pocket limits.
For Medi-Cal and Medicare patients, emergency air medical transportation is a covered benefit. Medi-Cal patients have no deductible, and many Medicare beneficiaries with supplemental policies find that these policies cover the required deductibles, co-pays, and coinsurance for air medical services.
It is crucial to note that non-emergency air transport may not be covered under the No Surprises Act. If a patient’s plan does not cover non-emergency air ambulance services, the act does not require the plan to do so, nor does it limit the amount a patient can be charged.
For uninsured patients or those who choose to pay out-of-pocket, the No Surprises Act provides protections through good faith estimates of care costs and dispute mechanisms for contested charges. Additionally, CIH has partnered with Dollar For to offer easy online applications for Charity Care, providing discounts or bill forgiveness based on income qualifications.
Catalina Island Health, dedicated to providing comprehensive care to the island community, operates a medical clinic at 100 Falls Canyon Road in Avalon, open Monday through Friday from 8 a.m. to 5 p.m. The emergency room is staffed 24/7 with UC Irvine Emergency Medicine Physicians, ensuring that the island’s acute medical needs are met. CIH consistently receives high patient satisfaction ratings for its emergency services.
For more information about the No Surprises Act, visit CMS.gov/nosurprises. For details on CIH’s services, visit CatalinaIslandHealth.org or call 310-510-0700.
