How an Air Ambulance Provider Recovered $4.1M in Disputed Claims
Navigating complex balance billing regulations with data-driven disputes
Regional Air Ambulance Provider
Regional Air Ambulance Provider
About
A regional air ambulance service providing critical care transport across the Mountain West, completing over 3,000 missions annually.
Industry
Air Ambulance / Emergency Medical Services
Company size
150-200 employees
Headquarters
Denver, CO
Founded
2009
Annual Claims
$45M+ billed annually
Key Features Used
Challenge
Air ambulance services face some of the highest rates of underpayment in healthcare. The provider was receiving an average of 22% of billed charges on out-of-network transports, with some payers paying as little as $5,000 for flights costing $35,000+ to operate.
Solution
Implement Clearest to build a comprehensive IDR program using air ambulance-specific benchmark data, including Medicare cost reports and peer transport company data, to demonstrate reasonable and customary rates for aeromedical services.
Illustrative Results
$4.1M recovered
Total revenue recovered in 14 months
89% win rate
On IDR disputes with transport cost documentation
$12,400
Average additional recovery per flight
156 disputes
Successfully resolved cases
The air ambulance payment crisis
Air ambulance services are essential for rural and remote areas where ground transport simply cannot reach patients in time. But the cost of maintaining helicopters, pilots, flight nurses, and 24/7 readiness creates significant fixed costs that must be recovered across a relatively small number of transports.
The air ambulance provider had been operating for over a decade, building a reputation for excellent patient outcomes. But their financial health was deteriorating. Payers were routinely paying 15-25% of billed charges, claiming their rates were "unreasonable" without providing any data to support that position.
The company was facing a choice: reduce services to rural communities or find a way to recover fair payment for the care they provided.
Illustrative perspective
We were being told our rates were unreasonable by payers who had no idea what it costs to keep a helicopter and medical crew ready 24/7. We needed data to fight back.
Building an air ambulance-specific case
Air ambulance IDR cases require specialized evidence. Standard physician benchmarks do not apply. Clearest built a comprehensive evidence package using Medicare cost reports, GAO studies on air ambulance costs, and actual payment data from peer transport companies.
Each dispute packet included detailed breakdowns of the actual cost to provide the service: aircraft depreciation, fuel, pilot salaries, medical crew costs, insurance, and base overhead. This cost-based approach proved highly effective with arbitrators.
The platform also tracked state-specific regulations, as several states have enacted balance billing protections that affect air ambulance disputes differently.
Winning with transparency
The key to the provider's success was radical transparency about costs. Rather than simply asserting that their rates were reasonable, every dispute included auditable cost documentation.
Arbitrators responded well to this approach. When payers offered $5,000 for a transport that demonstrably cost $28,000 to provide, the unreasonableness of the payer position became obvious.
Illustrative perspective
For the first time, we could show arbitrators exactly what it costs to save a life with air transport. The data spoke for itself.
Sustainable operations secured
The $4.1M recovery allowed the provider to maintain operations at all five bases and invest in upgraded medical equipment. More importantly, they now have a repeatable process for ensuring fair payment on every transport.
The company has also used their IDR success to renegotiate in-network contracts with several payers, using their win rate as leverage to secure better rates without disputes.
Illustrative perspective
Clearest did not just recover past revenue. They gave us the tools to ensure we can continue serving our communities for years to come.
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