II 

116TH CONGRESS 

2D SESSION S. 4185 

To establish an independent dispute resolution process for surprise air 

ambulance bills, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JULY 2, 2020 

Mr. WICKER introduced the following bill; which was read twice and referred 

to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To establish an independent dispute resolution process for 

surprise air ambulance bills, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘End Surprise Medical 

5 Bills for Air Ambulances Act of 2020’’. 

6 SEC. 2. ENDING SURPRISE AIR AMBULANCE BILLS. 

7 Part A of title XXVII of the Public Health Service 

8 Act (42 U.S.C. 300gg et seq.) is amended by inserting 

9 after section 2719A the following: 


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1 ‘‘SEC. 2719B. AIR AMBULANCE SURPRISE MEDICAL BILL 

2 DISPUTE RESOLUTION. 

3 ‘‘(a) ESTABLISHMENT OF INDEPENDENT DISPUTE

4 RESOLUTION PROCESS.— 

5 ‘‘(1) ESTABLISHMENT.—Not later than 30 days 

6 after the date of enactment of this section, the Sec7 retary, in consultation with the Secretary of Trans8 portation, shall establish an independent dispute res9 olution process for resolving balance bills between a 

10 health plan or a health insurance issuer offering 

11 health insurance coverage (in this section collectively 

12 referred to as a ‘health insurance issuer’) and an 

13 out-of-network air ambulance providers in accord14 ance with this section (referred to in this section as 

15 the ‘IDR process’). 

16 ‘‘(2) INDEPENDENT DISPUTE RESOLUTION EN17 TITY.—Under the IDR process, the Secretary in co18 ordination with the Secretary of Transportation, 

19 shall establish a list of qualified entities to serve as 

20 Independent Dispute Resolution Entities. In estab21 lishing this list of qualified entities, the Secretary 

22 shall require that the qualified entities have arbitra23 tors who have— 

24 ‘‘(A) a minimum of 10 years of experience 

25 in health care litigation but whom have not repVerDate Sep 11 2014 00:59 Jul 14, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4185.IS S4185

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1 resented a health insurance issuer or an air am2 bulance provider in the preceding 5 years; or 

3 ‘‘(B) a minimum of 15 years of experience 

4 in providing mediation and arbitration services. 

5 ‘‘(3) ARBITRATION PARAMETERS.—The IDR 

6 process shall require an arbitrator to do the fol7 lowing: 

8 ‘‘(A) Render a written decision resolving 

9 all disputes that designates 1 party as the ‘pre10 vailing party’. 

11 ‘‘(B) Use the following factors in deter12 mining the reasonable value of the services pro13 vided: 

14 ‘‘(i) The nature of the services pro15 vided and equipment used, including the 

16 care capability and scope of practice of the 

17 out-of-network air ambulance provider. 

18 ‘‘(ii) A comprehensive accounting of 

19 the out-of-network air ambulance pro20 vider’s costs, payor mix, revenue mix, and 

21 other economic factors of the out-of-net22 work air ambulance provider’s service. 

23 ‘‘(iii) Amounts paid (in- and out-of24 network) to the out-of-network provider. 


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1 ‘‘(iv) Amounts paid (in- and out-of2 network) to similar out-of-network air am3 bulance providers in the same geographic 

4 region if such data is available. 

5 ‘‘(v) Information provided by Federal 

6 data collection and reporting requirements, 

7 when available. 

8 ‘‘(vi) If available for the geographic 

9 area in which the flight took place, the me10 dian in-network rate. 

11 ‘‘(C) Not take into consideration bill 

12 charges when considering the amount to award. 

13 ‘‘(4) PROCESS REQUIREMENTS.—The IDR 

14 process shall require an arbitrator and parties ad15 here to the following process and timelines: 

16 ‘‘(A) The parties shall submit written sub17 missions to the arbitrator on or before the 30th 

18 day after initiating the IDR process. 

19 ‘‘(B) The arbitrator’s decision shall include 

20 written findings and be issued within 45 days 

21 after receipt of the parties’ written submissions. 

22 ‘‘(C) Any amount awarded by the arbi23 trator shall be paid within 20 days of the arbi24 trator’s final decision. 


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1 ‘‘(D) All proceedings and the arbitrator’s 

2 decisions made under the IDR process shall be 

3 confidential in nature and not subject to any 

4 disclosure requirements. 

5 ‘‘(E) The nonprevailing party shall be re6 sponsible for paying all fees charged by the ar7 bitrator. 

8 ‘‘(5) OTHER CONSIDERATIONS.—The IDR proc9 ess shall allow the arbitrator in making the arbitra10 tor’s final decision to take into consideration the 

11 number of previous instances in which the parties 

12 involved have had to undergo the IDR process. 

13 ‘‘(b) INDEPENDENT DISPUTE RESOLUTION PROC14 ESS.— 

15 ‘‘(1) IN GENERAL.—When an out-of-network 

16 air ambulance provider bills a health insurance 

17 issuer for an air ambulance service provided to a 

18 participant, beneficiary, or enrollee of the issuer, the 

19 health insurance issuer shall pay the billed amount 

20 or determine that the health insurance issuer con21 siders some or all of the claim to be disputed within 

22 30 days from receipt of the bill. If a claim is dis23 puted, the health insurance issuer shall notify— 

24 ‘‘(A) the out-of-network air ambulance pro25 vider in writing within 30 days of receipt of the 


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1 bill why the claim is disputed (in this subsection 

2 referred to as the ‘notice of dispute’); and 

3 ‘‘(B) the patient who received the out-of4 network air ambulance transport that the bill is 

5 disputed, that the health insurance issuer, and 

6 not the patient, is responsible for the disputed 

7 bill, and that the disputed bill will be resolved 

8 through the IDR process. 

9 ‘‘(2) RESOLUTION PROCESS.—The health insur10 ance issuer and the out-of-network air ambulance 

11 provider have 90 days from the date on which the 

12 provider receives a notice of dispute from the issuer 

13 to come to a settlement agreement for the disputed 

14 bill. 

15 ‘‘(3) ARBITRATOR SELECTION.—If the health 

16 insurance issuer and the air ambulance provider do 

17 not come to an agreement under paragraph (2) with18 in such 90-day period, the issuer and provider shall 

19 enter into the IDR process with an Independent Dis20 pute Resolution Entity selected at random from the 

21 list established under subsection (a)(2). Within 5 

22 business days of being selected, the Independent 

23 Dispute Resolution Entity shall assign an arbitrator 

24 to make a determination in the matter. 


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1 ‘‘(c) EFFECT OF DETERMINATION.—A final deter2 mination of the arbitrator assigned under subparagraph 

3 (b)(3) shall be binding on the issuer and provider. 

4 ‘‘(d) PRIVACY LAWS.—An arbitrator shall comply 

5 with all applicable Federal and State privacy laws in con6 ducting an IDR process under this section. 

7 ‘‘(e) PUBLIC AVAILABILITY.—The amount deter8 mined with respect to any claim by an arbitrator con9 ducting an IDR process under this section shall be con10 fidential, except that an arbitrator may access the 

11 amounts determined in any previous claims involving the 

12 health insurance issuer or the out-of-network air ambu13 lance provider that was resolved through the IDR process. 

14 ‘‘(f) AIR AMBULANCE ENFORCEMENT.—The Sec15 retary of Transportation shall require all air ambulance 

16 providers to participate in good faith in the IDR process. 

17 If an air ambulance provider fails to abide by the timelines 

18 established in this section during the IDR process, the 

19 Secretary of Transportation shall issue a fine of $20,000 

20 against the air ambulance provider unless the provider’s 

21 failure to abide by the timelines is attributable to the ac22 tions or inactions of the health insurance issuer. 

23 ‘‘(g) INSURERS ENFORCEMENT.—The Secretary shall 

24 require all health insurance issuers to participate in good 

25 faith in the IDR process. If an insurer fails to abide by 


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1 the timelines established in this section during the IDR 

2 process, the Secretary shall issue a fine of $20,000 against 

3 the health insurance issuer unless the issuer’s failure to 

4 abide by the timelines is attributable to the actions or in5 actions of the air ambulance provider. 

6 ‘‘(h) REEVALUATION.—Not later than 3 years after 

7 the establishment of the IDR process, the Secretary and 

8 the Secretary of Transportation jointly shall— 

9 ‘‘(1) conduct an evaluation of the process; and 

10 ‘‘(2) based on the results of such evaluation, de11 termine whether to continue or terminate the IDR 

12 process (after resolution of all disputed claims that 

13 are pending on the date the determination to termi14 nate the process is made). 

15 ‘‘(i) DEFINITION.—For purposes of this section, the 

16 term ‘air ambulance service’ means medical transport by 

17 helicopter or airplane for patients.’’. 

Æ 


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