Source Article | Comments Courtesy of Matt Zavadsky
Not necessarily a ‘new’ approach, but an interesting way to position a solution to the high balance-billing issue…
Alacura has also contacted area ground ambulance providers (MedStar in 2016) promoting similar contracting proposals.
FYI, Dr. Gamber is also the Medical Director for Plano Fire Department…
09/20/2018| by Shawn Shinneman
While some lawmakers at the federal level push for oversight to curb the enormous air ambulance bills that have grabbed headlines over the last few years, a Dallas company says it has a regulation-free solution.
Founded three years ago, Alacura has inserted itself as a middle man between providers—which typically have no financial skin in the game—and commercial insurance companies, which have caught flack for their willingness to pay for only a relatively small portion of transport-related bills, leaving patients with balances that sail into the tens of thousands of dollars.
Alacura has been able to cut deals with transport companies by promising a volume of “missions,” and by talking with insurers to figure out a price they’ll reimburse. Its contracts ensure that the payer covers the entire cost.
“It’s the patients that get stuck in the middle,” says David Boone, who founded Alacura in 2015, “and that’s ultimately what we’re trying to fix.”
Stories about high medical bills associated with airplane medical transports have not been hard to come by in recent years. The business model for major medical transport providers, says Alacura Medical Director Mark Gamber, has generally been to re-coop high overhead—related in-part to having highly trained personnel on call at all times—and transports of patients who don’t have insurance by charging commercially insured patients lots and lots of money.
Reporting from outlets like the Los Angeles Times and New York Times and St. Louis Post-Dispatch, among others, have exposed patient bills as high as $40,000 to $50,000 for in-state trips. Boone says some of the out-of-state trips run much higher, estimating that a large air transport provider would price a trip from Los Angeles to Chicago at somewhere around $600,000. He can do it for between $55,000 and $60,000, he says, at a tab the insurer picks up in full.
While some decisions have to be made very quickly, many of the patients who travel from one hospital to another via fixed-wing transports aren’t split-second decisions. There’s time for providers to call insurance companies, verify that the patients are in fact insured, and then make a call to put the transport teams into motion.
Gamber, an ER doctor, can see the issue from the provider’s perspective. Hospitals and physicians are time-strapped and have no financial incentive to bargain hunt on behalf of their patients. So the way Alacura has set it up, when an insurer gets a call from a provider to verify a patient’s insurance coverage, the insurer will tell them to call Alacura to set up the transport, Gamber says.
From there, Alacura chooses the appropriate transport company from within its network, and acts as the point man for communication should anything go wrong.
The company has contracts set up with Blue Cross Blue Shield in Texas, Illinois New Mexico, Arizona, and Michigan, and is completing about 30 missions a month and growing, Boone says.
So far, Alacura has been able to build its transport company network by targeting smaller and mid-sized companies, who seek the added volume. They credential the companies themselves to make sure they’re up to snuff, Gamber says. But both Gamber and Boone recognize that their model is in direct opposition to the business models at the largest transport companies in the country, one of which—Air Medical Group Holdings—is based right up Interstate 35E in Lewisville.
Those companies are so far reluctant to give up their position. If things go right for Boone and Gamber, Alacura might force their hand.
“There will be some bumps in the road, but ultimately where I think this will end is with partnering with more of them,” Gamber says. “There are some national-scope transport companies that will probably not appreciate what we’re doing and push back.
Hopefully we’ll be able to partner with one of those, because right now we have a lot of regional relationships. Ideally, we can develop a national relationship.”