Study of Proposed Mandatory Health Insurance Coverage for Medically Necessary Transportation from the State to the Continental United States for “Qualifying Patients”
From Hawaii State Auditor, Report No. 19-07, February 1, 2019
We found that there is a relatively low demand for air ambulance services to the continental United States, but costs for each case are high – estimates range from $42,000 to $112,000 for a single trip. In addition, the specific definition set forth in the proposed coverage could lead to unintended effects.
…When transportation from Hawai‘i to the continental United States for treatment is required, in most cases a patient can be transported via commercial airlines. We found that the number of patients that seek coverage for air ambulance services to the continental United States is very small. The two largest health insurance providers in the State reported a total of 28 members that were recommended for medical transportation to the continental United States for treatment in 2016 and 2017. Insurance coverage was not provided in 11 cases, all of which involved members from a single insurance provider. Several other health insurance providers reported that their policies currently cover the cost for those transportation services pursuant to Section 432E-1.4(a), HRS, titled Medical Necessity. The determination of “medical necessity,” however, is left to the health insurance provider. Because we were not given details as to the circumstances underlying the determinations that requested transportation was “medically unnecessary” and the denial of coverage for the above-mentioned 11 patients, we are unable to determine whether or not any of those cases involved “qualifying patients” under either HB 687 or HCR 52. …
Summary | Full Report (pdf)