UNITED STATES DISTRICT COURT 

NORTHERN DISTRICT OF FLORIDA 

TALLAHASSEE DIVISION 

 CASE NO. 

AIR METHODS CORPORATION and ROCKY 

MOUNTAIN HOLDINGS LLC, 

Plaintiffs, 

vs. 

DAVID ALTMAIER, in his official capacity as Commissioner 

of the Office of Insurance Regulation, 

 

Defendant. 

________________________________________________/ 

COMPLAINT FOR DECLARATORY 

AND INJUNCTIVE RELIEF 

Plaintiffs, Air Methods Corporation (“Air Methods”) and its wholly-owned 

subsidiary Rocky Mountain Holdings, LLC (“Rocky Mountain”) (collectively, “Air 

Methods”), by and through their undersigned attorneys, bring this civil action for 

declaratory and injunctive relief and allege as follows: 

1. This is an action to declare invalid and to permanently enjoin the 

enforcement of Florida House Bill 747, enacted on September 18, 2020, codified at 

new Florida Statutes sections 627.42397 and 641.514 (“HB 747”). The new law is 

unconstitutional and preempted by federal law, namely the Airline Deregulation Act 

of 1978 (“ADA”), 49 U.S.C. § 41713(b). 

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2. Congress included an express preemption clause in the ADA that 

prohibits states from “enact[ing] or enforc[ing] a law, regulation, or other provision 

having the force and effect of law related to a price, route, or service of an air carrier 

that may provide air transportation under this subpart.” 49 U.S.C. § 41713(b). 

3. Air Methods is an “air carrier” for purposes of the ADA because it is 

certified to provide interstate air transportation. See 49 U.S.C. § 40102(a)(2); see 

also Stout v. Med-Trans Corp., 313 F. Supp. 3d 1289, 1294-95 (N.D. Fla. 2018). 

4. The ADA prohibits state laws that regulate an air carrier’s pricing, even 

when the state law purports to apply only to transports within the state. See Scarlett 

v. Air Methods Corp., 922 F.3d 1053, 1060-61 (10th Cir. 2019). 

5. Despite the ADA’s well-established prohibition, HB 747 seeks to 

regulate the prices set by air ambulance service operators in the State of Florida 

(“State”) in two ways: first, by limiting reimbursement from health insurers based 

on select criteria; and second, by prohibiting any “balance billing” to patients for 

any amount over the reimbursement rate established under the statute. 

6. Because HB 747 seeks to regulate pricing for air ambulance services, 

there can be no question that HB 747 is preempted by the ADA, even if the new law 

is described and rationalized as an effort to regulate the business of insurance. 

7. Moreover, the new law is unconstitutionally vague as enforcement of a 

“reasonable reimbursement” rate will be at the whim of the insurers, who merely 

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“consider” certain factors but are not bound by any standards in determining the 

reimbursement rate. 

8. Additionally, the federal government is currently working with both 

health insurers and air ambulance service providers to address pricing and balance 

billing issues in the air ambulance industry on a nationwide basis. The FAA 

Reauthorization Act of 2018 established an Air Ambulance and Patient Billing 

(“AAPB”) Advisory Committee that already has provided a report to the U.S. 

Department of Transportation (“DOT”) this year for purposes of issuing national 

guidance and rules in order to prevent the application of inconsistent state laws like 

HB 747. 

9. At bottom, HB 747 manifestly regulates the pricing of air ambulance 

operators in Florida in explicit violation of the ADA, and must be declared 

unconstitutional and invalid. 

JURISDICTION AND VENUE 

10. The Court has subject matter jurisdiction over this action pursuant to 

28 U.S.C. § 1331 because the action arises under (i) the Supremacy Clause of the 

Constitution of the United States, Article VI, clause 2 (“the Supremacy Clause”); 

and (ii) the laws of the United States, specifically the Airline Deregulation Act of 

1978, 49 U.S.C. § 41713(b)(1). Additionally, subject matter jurisdiction arises under 

28 U.S.C. § 1337, because the matter in controversy arises under an Act of Congress 

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regulating commerce, i.e., the ADA, and the Federal Declaratory Judgment Act, 28 

U.S.C. §§ 2201-2202, because this is an actual controversy in which Plaintiffs seek 

declaratory relief. 

11. Venue is proper in the Northern District of Florida pursuant to 28 

U.S.C. § 1391(b) because Defendant performs his official duties and transacts his 

affairs in this District, and a substantial part of the events giving rise to the claims 

occurred in this District. 

PARTIES 

12. Air Methods, operating through its subsidiary Rocky Mountain, 

provides life-saving, emergency transport to critically injured patients in many states 

throughout the country, including the State of Florida. 

13. Air Methods is certified by the Federal Aviation Administration 

(“FAA”) as an on-demand air carrier that is subject to pervasive federal regulation. 

14. Air Methods employs medical professionals and flight crews, owns and 

operates air medical service helicopters, and maintains all required state and local 

licensure and insurance that enables it to provide life-saving transportation services 

to those in need. 

15. Defendant David Altmaier, the Commissioner of the Florida Office of 

Insurance Regulation (“OIR”), is sued in his official capacity. The Commissioner’s 

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office is charged with enforcing the law at issue. See Fla. Stat. § 20.121(3)(a)1. His 

office is located at 200 East Gaines Street, Tallahassee, Florida 32399. 

FACTUAL BACKGROUND

A. Air Methods’ Life-Savings Operations in Florida 

16. Air Methods is a federally regulated air carrier that provides life-saving 

emergency air transportation services to critically ill and injured patients. 

17. Air Methods provides these emergency air ambulance services 

throughout the State of Florida to destinations in Florida and across state lines into 

neighboring states. 

18. Air Methods has 14 different bases located across Florida: from 

Escambia County in the Panhandle to Jacksonville in Northeast Florida to St. Lucie 

in Southeast Florida to Lee County in Southwest Florida. 

19. Air Methods operates on average one or two emergency air transports 

on a daily basis from each one of these 14 locations. 

20. Air Methods also serves several under-served rural communities, and 

transports patients from these rural communities to higher care facilities located in 

metro areas of Florida. 

21. Air Methods is authorized by the FAA to operate as a Part 135 air 

carrier providing on-demand air ambulance services. 

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22. Air Methods also is registered with the DOT to operate as a Part 298 

air taxi operator providing on-demand services. 

23. Pursuant to its Part 135 certificate and Part 298 registration, Air 

Methods is authorized to operate interstate flights and, as a common carrier for 

compensation, qualifies as an “air carrier” as that term is defined in the ADA. 

24. Air Methods maintains a fleet of air ambulances, fixed wing aircraft 

and helicopters, that are prepared to respond at a moment’s notice to medical 

emergencies. It provides life-saving emergent air ambulance transportation to 

critically ill or injured patients, while medical professionals provide in-flight care. 

25. Air Methods is dispatched by first responders at the scene of an accident 

or by a physician or medical facility that determines a patient requires emergency 

transport to a hospital that can offer a higher level of care. 

26. In accordance with federal and state law, Air Methods serves patients 

in its aircraft regardless of their insurance status or their ability to pay for the 

services. 

27. To continue to provide air ambulance service to every patient regardless 

of their ability to pay, Air Methods must receive its billed charges for a sufficient 

proportion of its flights to offset the losses it suffers when it transports patients who 

are uninsured, underinsured or are covered by Medicare or Medicaid. 

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B. Florida House Bill 747 

28. On November 22, 2019, HB 747 was introduced as a bill in the Florida 

House of Representatives. The purpose of HB 747 is to regulate the prices air 

ambulance service providers can receive in the State of Florida from its patients and 

their health insurers. 

29. On March 12, 2020, the Florida Legislature passed HB 747. 

30. On September 18, 2020, the Governor of Florida signed HB 747 and 

the law took effect immediately. 

31. Under HB 747, Florida Statutes are amended to limit the prices that air 

ambulance operators can receive for their transportation services from their patients’ 

health insurers. By definition, the reimbursement required under the statute must be 

something less than the air ambulance service provider’s billed charges. 

32. HB 747 accomplishes this impact by mandating that health insurers 

provide “reasonable reimbursement” to an air ambulance service for covered 

nonemergency and emergency services provided to an insured in accordance with 

the coverage terms of the policy. Air ambulance operators are forced to accept this 

vague and lower reimbursement rate, which is expressly not based upon air 

ambulance operators’ billed charges. 

33. Additionally, the air ambulance operators must accept any “payment by 

the insured of his or her applicable copayment, coinsurance, or deductible constitutes 

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an accord and satisfaction of, and constitutes a release of, any claim for additional 

moneys owed by the insured to the health insurer or to any person or entity in 

connection with the air ambulance service.” Fla. Stat. § 627.42397(1)(c)(2). 

34. The enforcement of HB 747 will likely result in significant economic 

losses to Air Methods. These losses will be immediate as Air Methods operates 

daily life-saving flights. Indeed, the Florida legislators fully recognize that HB 747 

will have a “negative, indeterminate fiscal impact” on air ambulance service 

providers.1

 

35. Moreover, because Air Methods cannot balance bill the patient under 

the new law, the law will cap all reimbursement well below the prices set by Air 

Methods. 

36. Even more concerning is that Air Methods will be forced to evaluate 

the ongoing financial viability of operations in the State as a result of the anticipated 

significant loss of revenue under HB 747. Indeed, the new law leaves little, or no, 

incentive for insurers to negotiate in good faith with Air Methods regarding innetwork rates. 

 

1 See House of Representatives Staff Final Bill Analysis for HB 747 (“House 

Report”) (2020), at 6, available at 

https://www.flsenate.gov/Session/Bill/2020/747/Analyses/h0747z.HMR.PDF.   

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D. The Airline Deregulation Act 

37. In 1978, Congress amended the Federal Aviation Act of 1958, 49 

U.S.C. § 40101 et. seq., and enacted the ADA with the intention of deregulating the 

aviation industry. 

38. Congress included an express preemption clause in the ADA that 

prohibits states from “enact[ing] or enforc[ing] a law, regulation, or other provision 

having the force and effect of law related to a price, route, or service of an air carrier 

that may provide air transportation under this subpart.” 49 U.S.C. § 41713(b)(1). 

39. This express preemption clause was included “to ensure that States 

would not undo federal deregulation with regulation of their own,” Morales v. Trans 

World Airlines, Inc., 504 U.S. 374, 378 (1992), and to “prevent conflicts and 

inconsistent regulations” of air carriers by the federal government and the 50 states. 

H.R. Rep. No. 95-1211, at 16 (1978).

40. In passing the ADA, Congress determined that “an air transportation 

system relying on actual and potential competition” would best further “efficiency, 

innovation, and low prices” as well as “variety [and] quality . . . of air transportation 

services.” 49 U.S.C. § 40101(a)(12).

41. Congress also recognized that it is in the public interest to place 

“maximum reliance on competitive market forces and on actual and potential 

competition − (A) to provide the needed air transportation system; and (B) to 

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encourage efficient and well-managed carriers to earn adequate profits and attract 

capital.” 49 U.S.C. § 40101(a)(6).

42. The ADA’s preemption clause is interpreted broadly, and preemption 

is found where claims, directly or indirectly, have “a connection with, or reference 

to” an air carrier’s prices, routes or services. See Nw., Inc. v. Ginsberg, 572 U.S. 

273, 280-81 (2014); see also Am. Airlines, Inc. v. Wolens, 513 U.S. 219 (1995); 

Morales v. Trans World Airlines, Inc., 504 U.S. 374 (1992).2

43. HB 747’s ill-conceived pricing scheme is federally preempted by the 

ADA for the same reasons as those found by the U.S. Court of Appeals for the 

Eleventh Circuit in Bailey v. Rocky Mountain Holdings, LLC, 889 F.3d 1259, 1271 

(11th Cir. 2018) (finding ADA preemption because “the balance billing provision 

has ‘the forbidden significant effect’ on the prices of an air carrier”), and several 

other federal court decisions. See EagleMed LLC v. Cox, 868 F.3d 893, 905 (10th 

Cir. 2017) (holding fee schedules in workers compensation act were preempted 

because they regulated air ambulances’ prices); Guardian Flight, LLC v. Godfread, 

359 F. Supp. 3d 744, 755 (D.N.D. 2019) (finding ADA preempted state law setting 

 

2

 To the extent the Commissioner asserts reverse preemption under the McCarranFerguson Act, it is clear that HB 747 regulates the activities of an air ambulance 

operator by setting the price for the services and including a balance billing 

prohibition, and is therefore not limited to the relationship between the insured and 

the insurer. 

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state-mandated rate and prohibition on balance billing because interfered with air 

ambulance prices), appeal docketed, No. 19-1381 (8th Cir. Feb. 25, 2019); Air Evac 

EMS, Inc. v. Cheatham, 260 F. Supp. 3d 628, 633 (S.D. W. Va. 2017) (holding ADA 

preempted West Virginia law prohibiting air ambulance companies from balance 

billing patients insured by West Virginia’s Public Employees Insurance Agency), 

aff’d, 910 F.3d 751 (4th Cir. 2018); Valley Med Flight, Inc. v. Dwelle, 171 F. Supp. 

3d 930, 943 (D.N.D. 2016) (holding ADA preempts North Dakota workers’ 

compensation fee schedule and balance billing prohibitions).

44. The House Report for HB 747 and the Senate Report regarding the 

sister Senate Bill (SB 736) expressly recognize the foregoing cases, including the 

Eleventh Circuit Bailey decision, and the various states’ repeated failed efforts to 

enact new laws or enforce state fee schedules in an attempt to cap or restrict air 

ambulance prices.3

 Additionally, the Senate Report predicted that the new law will 

be struck down given the breadth of the ADA’s prohibition of state regulation of air 

carrier prices.4

 

3 See House Report, at 3-4; Senate Bill Analysis and Fiscal Impact Statement for SB 

736 (the sister bill to HB 747) (“Senate Report”), at 7-8 (2020), available at 

https://www.flsenate.gov/Session/Bill/2020/736/Analyses/2020s00736.rc.PDF 

4

 See Senate Report, at 11 (recognizing ADA preemption as one of the “Technical 

Deficiencies” with the new law). 

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45. The DOT’s Office of the General Counsel also has reinforced an 

expansive view of preemption and reliance on market forces, specifically in the air 

ambulance context. In its Guidelines for the Use and Availability of Helicopter 

Emergency Medical Transport (HEMS),

5

 the Office of the General Counsel 

summarizes its various opinions on FAA and ADA preemption in air ambulance 

cases. In discussing federal preemption of state laws that require certificates of 

authority to operate in the state, the Office notably confirmed that: 

[o]nce the Secretary [of Transportation] certificates an air ambulance 

operator, the competitive marketplace, rather than state regulations, 

controls the operator’s prices, routes, and services, and only the 

Secretary may revoke an air ambulance operator’s certificate.

Id. at 11 (emphasis added). 

E. The FAA Reauthorization Act of 2018 

46. The FAA Reauthorization Act established an Air Ambulance and 

Patient Billing (“AAPB”) Advisory Committee, comprised of health insurers and air 

ambulance operators, to review ways to improve the disclosure of air ambulance 

charges, better inform consumers of insurance options, and protect them from 

balance billing. Pub. L. No. 115-254, § 418, 132 Stat. 3186, 3334-3336 (2018). 

 

5 Available at

https://www.transportation.gov/sites/dot.gov/files/docs/Guidelines%20for%

20the%20Use%20and%20Availability%20of%20Helicopter%20Emergency

%20Medical%20Transport%20%28HEMS%29%20OCR.pdf

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47. The AAPB met earlier this year and issued a report, which the DOT is 

presently using to conduct oversight of air ambulance service providers and to issue 

forthcoming guidance concerning provider pricing and billing practices. This will 

include guidance for States to refer such matters to the Secretary of Transportation. 

Pub. L. No. 115-254, § 420, 132 Stat. 3336. 

48. DOT has plenary authority to investigate allegedly unfair business 

practices of air ambulance operators, including complaints concerning prices and 

balance billing, and bring enforcement actions. See 49 U.S.C. § 41712(a). DOT 

reviews consumer complaints to determine compliance with federal law and identify 

areas of concern that serve as the basis for federal rulemaking and legislation. 

Count I: Declaratory Judgment that HB 747 Is Preempted By the ADA 

and Injunctive Relief to Enjoin Its Enforcement 

49. Plaintiffs repeat and reallege paragraphs 1 through 48 of this Complaint 

as though fully set forth herein.

50. HB 747 is preempted by the ADA because it “relates to” the prices and 

services provided by air ambulance service providers in Florida, including Air 

Methods. 

51. Specifically, HB 747 directly affects the prices that air ambulance 

operators may charge because the operator will be required to accept the prices 

mandated by the statute, which by definition will be less than the billed charges of 

the operator. 

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52. Air Methods, if unable to set its air carrier rates to sustain its operations 

in the State, will likely be forced to cease its critical life-saving operations in many 

counties, including the rural communities in Florida, with such cessation at the 

expense of the life and health of Florida’s citizens. 

53. Because HB 747 (i) authorizes health insurers to determine Air 

Methods’ prices by setting reimbursement rates and prohibiting balance billing, and 

(ii) threatens Air Methods’ ability to continue to provide services to the Florida 

emergency air transport market, the statute is preempted by the ADA and this Court 

should declare HB 747 invalid and unenforceable.

Count II: Declaratory Judgment that HB 747 Violates the Supremacy Clause 

of the U.S. Constitution and Injunctive Relief to Enjoin Its Enforcement 

54. Plaintiffs repeat and reallege paragraphs 1 through 53 of this Complaint 

as though fully set forth herein.

55. Pursuant to Article VI, Section 2 of the U.S. Constitution (the 

Supremacy Clause), any state statute, rule or regulation that conflicts with federal 

law is preempted. 

56. Specifically, HB 747 is unconstitutional and conflicts with the ADA, 

which prohibits states from enacting or enforcing laws that relate to prices, routes or 

services of air carriers such as Air Methods. 

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57. Additionally, HB 747 conflicts with the FAA Reauthorization Act, 

which specifically designates the DOT to oversee and issue guidance and rules on 

pricing and balance billing practices in the air ambulance industry. 

58. Accordingly, this Court should declare that the provisions of HB 747 

are invalid and unenforceable because they violate the Supremacy Clause of the U.S. 

Constitution, Article VI.

Count III: Declaratory Judgment that HB 747 Is Unconstitutionally 

Vague and Injunctive Relief to Enjoin Its Enforcement 

59. Plaintiffs repeat and reallege paragraphs 1 through 58 of this Complaint 

as though fully set forth herein.

60. HB 747 is unconstitutionally vague in not defining “reasonable 

reimbursement,” therefore leaving Plaintiffs as air ambulance providers uncertain 

what they will be reimbursed for their services. 

61. While the new statutes list factors that may be considered in creating 

the “reasonable rates,” it is unclear how the health insurer will weigh or calculate 

these factors. Essentially, the new law leaves the insurer with carte blanche in 

setting the reimbursement rate.

PRAYER FOR RELIEF 

Wherefore, Plaintiffs request that the Court:

(1) Issue a declaratory judgment that declares HB 747 invalid and 

unenforceable as preempted by the Constitution and laws of the United 

States; 

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(2) Issue a preliminary injunction, the same to be made permanent on final 

 judgment: 

(a) Restraining and enjoining defendant, his employees, or agents from 

enforcing or seeking to enforce the provisions of HB 747 determined 

by this Court to be invalid and preempted by federal law; and 

 

(b) Requiring defendant to issue such notices, and take such steps as 

shall be necessary and appropriate to carry into effect the substance and 

intent of paragraph (a) above, including but not limited to the 

requirement that defendant publicly withdraw, and rescind any orders 

that seek to enforce, the provisions of HB 747 herein determined by this 

Court to be preempted by federal law; and 

(3) Grant such other further or different relief as to which the Plaintiffs may 

be entitled.6

Dated: September 24, 2020 HOLLAND & KNIGHT LLP 

Attorneys for Plaintiffs 

/s/ Tiffany A. Roddenberry 

Tiffany A. Roddenberry 

Florida Bar No. 92524 

Email: tiffany.roddenberry@hklaw.com 

315 South Calhoun Street, Suite 600 

Tallahassee, FL 32301 

Tel: (850) 425-5658 

/s/ Judith R. Nemsick 

Judith R. Nemsick 

(pro hac vice forthcoming) 

Email: judy.nemsick@hklaw.com 

31 West 52nd Street 

New York, NY 10019 

Tel: (212) 513-3200 

 

6

 Air Methods reserves the right to amend this complaint or file a separate action 

against insurers who restrict payments in reliance upon this preempted state law. 

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/s/ Philip E. Rothschild 

Philip E. Rothschild 

Florida Bar No. 88536 

Email: phil.rothschild@hklaw.com 

515 East Las Olas Boulevard, 12th Floor 

Fort Lauderdale, FL 33302-4070 

Tel: (954) 525-1000

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