In-Network Health Plans
Summary of Billing and Claim Process
Summary of Billing and Claims Process
Life Flight Network acknowledges medical billing can be complicated and confusing. We want to provide YOU- the patient or responsible party, with clear information about our billing process so you may gain a better understanding of this difficult process. We know how stressful being transported by an ambulance can be, especially an air ambulance. We are committed to demonstrating the same care and compassion you received from the medical crew who treated and transported you, all the way through to the conclusion of the billing process and your Life Flight Network experience.
Below is a step-by-step description of a typical claims and billing process, as well as information about Life Flight Network’s financial assistance program.
Step 1: Search for Benefits
Life Flight Network will work to find out what insurance benefits – individual or employer-sponsored health plan, original Medicare, a private Medicare Advantage plan, Medicaid or other third-party resources are available to be billed.
If you are a Life Flight Network member, Life Flight Network will add membership benefits to the transport. If at any time you feel you have received a Life Flight Network invoice by mistake, please contact our billing office at (866) 883-9998.
If you are a member of another air ambulance’s membership program that is a reciprocal partner of Life Flight Network, please make sure you report this to our billing office at (866) 883-9998. A list of reciprocal partners as well as membership benefits can be found at lifeflight.org.
If we cannot locate any insurance benefits, we will mail a Life Flight Network Request for Insurance and Signature form to the address we have on file. This is your opportunity to report the benefits you want to use.
Step 2: Billing Process Starts
Generally, within 30 days of collecting your insurance information, Life Flight Network will file a claim on your behalf.
If you do not have any type of insurance and you are a Life Flight Network or Reciprocal Program member, we will review the transport to confirm it was emergent, medically necessary and to the closest appropriate facility. If so, there will be no out of pocket cost to you. Skip to “Step: 9 Final Invoice Available“.
If you were enrolled through a group membership with 100 or more participants, the membership benefit cap is $10,000 per transport. The transport will be reviewed to confirm it was emergent, medically necessary and to the closest appropriate facility. If so, we will reduce the balance due by $10,000. Skip to “Step: 8 Invoice Mailed to Patient or Responsible Party“.
If there are no insurance benefits available and you are a Life Flight Network or Reciprocal Program member, skip to “Step: 8 Invoice Mailed to Patient or Responsible Party“.
Step 3: Insurer Reviews Claim and Determines Reimbursement
Life Flight Network is an “in-network” provider with the following commercial insurers: Blue Cross of Idaho, Pacific Source, Blue Cross Blue Shield of Montana, Allegiance Benefit Plan, and Cigna in Montana. If you have health insurance through one of these major insurers, the fee for your transport will be paid by your health plan and you will only be billed for the co-pay, co-insurance and deductible, per your plan benefits, when a claim is approved for payment. We strive to become an in-network provider with as many commercial insurers as reasonably possible and we expect this list will grow in the future.
If your health plan is not listed above, Life Flight Network is an “out-of-network” provider. This means your insurance company will decide on its own how much of Life Flight Network’s fee they will pay. Many insurance companies will pay the entire invoice; a few will choose to pay much less and pass the burden of the invoice onto you.
If you are unfortunate enough to have an insurance company who decides to pass along a significant portion of the invoice to you, they may provide feedback that sounds reasonable, but is not.
“We pay 200% of the Medicare rate” or “Life Flight Network charges are 5 times higher than the Medicare reimbursement rate.” These statements might sound good, but they are deceptive as the amount Medicare reimburses has nothing to do with how much the service costs.
“By accepting payment, Life Flight Network agreed to discount their charges.” This simply isn’t true. We have no control over what the insurance company chooses to pay.
“Life Flight Network is prohibited from balance billing.” If you are unfortunate enough to have an insurance company who pays less than 100 percent of the billed fee, you are responsible for the remaining balance.
If Medicaid is your primary insurance, Life Flight Network will accept Medicaid reimbursement as payment in full as required by law. Refer to “Step: 9 Final Invoice Available“.
Step 4: Insurer Issues Statement
You should receive an Explanation of Benefits, also referred to as an “EOB” or Summary Notice, from your primary insurer informing you of the total fee billed, what portion of that fee your insurer will pay, and what portion you are responsible for. Again, if Life Flight Network is out- of -network with your health plan the amount your insurance company will pay is completely up to them. They may choose not to pay ANYTHING.
If the claim is denied or you disagree with the reimbursement, skip to “Step: 5 Claim Denied or You Disagree with Reimbursement“. If the insurance statement indicates the insurer intends to issue payment, skip to “Step: 6 Insurer Issues Payment“.
Step 5: Claim Denied or You Disagree with Reimbursement
If your insurance company says the transport is not covered, Life Flight Network will manage the appeal of the decision on your behalf. Some insurers may require authorization to complete the appeal. In this instance, an invoice is sent asking you to contact your insurer’s Member Services Department. If you don’t authorize Life Flight Network to perform an appeal on your behalf, the balance due will be your responsibility. Neither Life Flight Network membership benefits nor financial assistance are available in this case.
If you disagree with the amount your plan paid, you may file an appeal with them or work with your employer’s Benefit Plan Administrator to ensure the plan makes the proper payment on your behalf. You can also reach out to your state insurance commissioner.
If the insurer does not issue additional reimbursement or issues less than 100 percent of billed charges, skip to “Step: 6 Insurer Issues Payment“.
Step 6: Insurer Issues Payment
Your insurer should issue payment directly to Life Flight Network. If payment is 100 percent of billed charges, skip to “Step: 9 Final Invoice Available”.
If your insurer pays less than 100 percent of billed charges and you are enrolled in Life Flight Network’s Membership Program or we have verified you are a Reciprocal Program member, we will review your transport details and apply membership benefits according to the program rules. If the transport qualifies, there will generally be no out-of-pocket cost to you. Skip to “Step: 9 Final Invoice Available“.
If your insurer pays less than 100 percent of billed charges and supplemental insurance is available, skip to “Step: 7 Claim Submitted to Supplemental Insurance“.
If your insurer pays less than 100 percent and neither supplemental insurance nor membership benefits are available, skip to: “Step: 8 Invoice Mailed to Patient or Responsible Party“.
Some out-of-network insurers send payments directly to the patient or the policyholder as reimbursement. It is important to know in this case the patient is responsible for remitting payment to Life Flight Network, in the full amount of the reimbursement received from the insurer, within 2 weeks of receiving a check. If we don’t receive the check, we will not be able to bill any supplemental insurance on your behalf and you will be immediately responsible for the full balance due. Neither Life Flight Network membership benefits nor financial assistance are available in this instance.
Step 7: Claim Submitted to Supplemental Insurance
If your insurance pays less than 100 percent of the billed fee, the remaining balance will be billed to the next supplemental insurance available. Life Flight Network will continue to work with you to identify all potential sources of payment.
At the end of the supplemental billing process, there may still be a balance due. If there are additional supplemental benefits available, we will submit additional claims.
If there are no additional supplemental benefits available and you are enrolled in Life Flight Network’s Membership Program or we have verified you are a Reciprocal Program member, we will review your transport details and apply membership benefits according to the program rules. If the transport qualifies, there will generally be no out-of-pocket cost to you. Skip to “Step: 9 Final Invoice Available“.
If there are no additional supplemental or membership benefits available, go to “Step: 8 Invoice Mailed to Patient or Responsible Party“.
In most cases, if Medicaid is your secondary insurer, Life Flight Network will waive the remaining balance due. Skip to “Step: 9 Final Invoice Available“.
Step 8: Invoice Mailed to Patient or Responsible Party
If your insurer pays less than 100 percent of the billed fee and no additional benefits have been identified, Life Flight Network will mail an invoice to you.
This may be the first opportunity you’ve had to review the charges for the ambulance service. It is important to know Life Flight Network does not financially screen patients prior to providing emergent transport. When we transport a patient, we have no idea what insurance benefits, if any, will be billed.
Health care and aviation services are heavily regulated and very expensive. The cost for a transport is determined by many factors including distance traveled and the care provided during transport. The fees reflect the quality of our program through our investment in safety, the training and expertise of our mechanics, pilots, intensive care nurses, paramedics, respiratory therapists and EMTs, the aircraft and ground units employed, and the sophistication of the medical equipment and supplies on our aircraft and ground units. There are no shareholders or private owners in Life Flight Network. Any money left over after paying our expenses is reinvested in our mission to promote the health, welfare and wellness of the communities we serve.
If the final balance due presents a financial hardship, you may be eligible for financial assistance through Life Flight Network’s robust financial assistance program. Eligibility is determined based on family size, household income, and other financial information. Life Flight Network Financial Assistance Applications are available on our website at lifeflight.org and upon request. We also offer payment plans.
Step 9: Final Invoice Available
Once the transport has a zero balance due, you may request a final invoice which will act as your receipt.
Please note the typical billing process may take up to 120 days or longer. We make every attempt to facilitate a seamless, efficient process. If you have any questions, please contact our billing office at (866) 883-9998.