IN THE UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF FLORIDA

TALLAHASSEE DIVISION

AIR METHODS CORPORATION AND 

ROCKY MOUNTAIN HOLDINGS LLC,

Plaintiffs,

v. v. Case No. 4:20-cv-462-AW-MAF

DAVID ALTMAIER, in his official 

capacity as Commissioner of the 

Office of Insurance Regulation,

Defendant.

/

DECLARATION OF ANOUSH ARAKALIAN BRANGACCIO 

I, Anoush Arakalian Brangaccio, pursuant to 28 U.S.C. § 1746, make 

this declaration under penalty of perjury, and declare that the statements made below 

are true:

1. My name is Anoush Arakalian Brangaccio. I am employed by the

Florida Office of Insurance Regulation (OIR) as General Counsel. My business 

address is 200 East Gaines Street, Tallahassee, Florida 32399.

 EXHIBIT A

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2. My duties as General Counsel include providing legal advice to the

Commissioner and oversight of OIR’s Legal Division. Accordingly, I am familiar 

with the operations of the OIR as well as the Florida Insurance Code.

1

3. In my capacity as General Counsel, I am also familiar with chapter

2020-177, Laws of Florida, which became law on September 18, 2020.

4. Chapter 2020-177 defines the term “reasonable reimbursement,” and

mandates that health insurance policies and health maintenance organization (HMO) 

contracts require health insurers and HMOs to provide “reasonable reimbursement” 

for air ambulance services.

5. Chapter 2020-177 also provides that payment in full by an insured

under a health insurance policy or an HMO subscriber of his or her required 

copayment, coinsurance and deductible for air ambulance services operates as an 

accord and satisfaction of, and a release of, any claim that a provider of air 

ambulance services may have against the insured or HMO subscriber. This 

provision prohibits what is known as “balance billing” of an insured or HMO 

subscriber by a provider of air ambulance services. 

6. The duties of the OIR under chapter 2020-177 is limited to ensuring

that health insurance policies and HMO contracts approved by OIR for issuance in 

1 The Florida Insurance Code comprises chapters 624-32, 634-36, 641-42, 648 and 

651, Florida Statutes. § 624.01, Fla. Stat.

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Florida on or after September 18, 2020 comply with this law. It is OIR’s position 

that Chapter 2020-177 does not apply to policies and contracts that were in place on 

September 18, 2020.

7. OIR has no authority to resolve or adjudicate any dispute which may

arise between a health insurer or HMO, on one hand, and a provider of air ambulance 

services on the other, over the payment of “reasonable reimbursement.” Such a 

dispute would have to be resolved in a civil lawsuit.

8. Likewise, OIR has no authority to resolve or adjudicate any dispute

which may arise between a provider of air ambulance services on one hand, and an 

insured or HMO subscriber on the other, over balance billing by the provider. As 

with the reasonable reimbursement provision, a dispute over balance billing would 

have to be resolved by means of a civil lawsuit.

FURTHER DECLARANT SAYETH NOT.

I declare under penalty of perjury that the foregoing is true and correct 

pursuant to Title 28 U.S.C. §1746. 

 Executed on October 30, 2020.

/s/ Anoush Arakalian Brangaccio

Anoush Arakalian Brangaccio

 General Counsel, Office of Insurance Regulation

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