Catalina Island residents, boaters, and even regular visitors may be familiar with air medical memberships. This membership coverage could be used in the unfortunate situation that Catalina Island Health was unable to provide the proper care for a patient and an air ambulance was required. Air medical services, like Mercy Air, would be called to transport the patient to a hospital on the mainland. The bill for that service could be quite large but times have changed.
If you have health insurance, you are protected. For that reason, Catalina Island Health wants the public to be aware of the No Surprises Act.
Since Jan. 1, 2022, the No Surprises Act protects patients from large balance bills and surprise costs related to emergency medical care – including air ambulance transport. 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. It does not matter who the insurance provider is or if the patient has in-network or out-of-network insurance. The patient cannot get a surprise or “balance bill” no matter who is transporting them, thus making the need for air medical memberships obsolete.
The following protections occur when surprise billing is not allowed:
- If the patient is out-of-network, they pay their normal share as if the provider or facility was in-network. Their health plan will pay out-of-network providers and facilities directly.
- In general, a patient’s health plan must:
—Cover emergency services without requiring you to get approval for services in advance (often called prior authorization).
—Cover emergency services by out-of-network providers.
—Base what you owe the provider or facility on what you would pay an in-network provider or facility and show that amount in your explanation of benefits.
—Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you are a Medi-Cal or Medicare patient:
- Emergency air medical transportation is a covered benefit for both Medicare (Part B) and Medi-Cal patients.
- Medi-Cal patients have no deductible at all.
- Most Medicare beneficiaries have a Medicare Supplement policy. If a patient is a Medicare beneficiary, many Medicare-approved and regulated Medicare Supplement policies will cover required deductibles, co-pays and coinsurance for many medical services, including air medical services.
Please note: Non-emergency air transport may not be covered. If non-emergency air ambulance services are not covered under the terms of a patient’s plan or coverage, the No Surprises Act does not require the plan or issuer to cover those services or limit the amount a participant, beneficiary, or enrollee may be charged for those services.
If you do not have insurance or choose to pay out of pocket for any medical services, the No Surprises Act includes protections in which you can often get a good faith estimate of the cost of your care up front, before your visit. If you disagree with your bill, you may be able to dispute the charges.
For all patients: If you have trouble paying your medical bills, CIH has partnered with Dollar For to make it easy to apply for Charity Care online, for free.
Charity Care provides discounts or bill forgiveness based on income qualifications. Anyone can apply. To learn more, visit CatalinaIslandHealth.org/need-help-paying-your-bill.
To learn more about the No Surprises Act, visit CMS.gov/nosurprises.
About Catalina Island Health
CI Health’s primary care physicians and family nurse practitioners provide the island community with a solid foundation of care.
The medical clinic is located at 100 Falls Canyon Road, Avalon, CA, up the street from Avalon’s City Hall on the bottom level of the hospital. Its hours are 8 am to 5 pm, Monday through Friday. Visit CatalinaIslandHealth.org or call 310-510-0096 for more information or to make an appoint ment.
The emergency room is staffed 24/7 with a UC Irvine Emergency Medicine Physician and supported by the CI Health’s laboratory and diagnostic imaging departments to meet the acute medical needs of Catalina Island’s residents and visitors. With the use of patient satisfaction surveys, patients consistently rank CI Health’s emergency services as one of the best in the nation.
The hospital’s main number is 310-510-0700. For more information, visit CatalinaIslandHealth.org.
