Insurance Needs and Options
Participants
Because transport team members are exposed to activities that might place them at greater risk of injuries or death, program administrators are often asked to provide additional insurance coverage for them while in the transport environment.
Team members must be adequately covered for the risks undertaken during transport on a daily basis. Unlike personnel who function solely in a hospital environment, transport team members are exposed to a higher risk of accidents during ground and air transports. Although it has been determined that collisions and crashes by pediatric and neonatal teams are uncommon, collective data suggest that 1 collision or crash occurs for every 1000 patient transports. Collisions or crashes involving injury or death are less common and occur at rate of approximately 0.546 per 1000 transports. Although death occurs most frequently as the result of aircraft crashes, ground collisions accounted for most transport-related injuries. Injuries sustained during ground collisions tend to be moderate to severe and in a category that can affect a victim's ability to work (see Chapter 10).Patients
Hodge9 stated that the growth of managed care has provided health benefits to millions of children while attempting to control the increase in health care costs. Transport team administrators find that third-party payers frequently require preapproval for transport coverage. Many programs have found it important to work proactively and partner with third-party payers and define groups of patients who will meet criteria for transport. Medicaid rules and notification requirements are different in each state, and, as new programs are developed, Medicaid reimbursement can be adjusted or denied. It is, therefore, important for transport team administrators to remain aware of Medicaid reimbursement rules and trends in their respective states to ensure optimal Medicaid reimbursement. Approval for transport is not synonymous with payment for that transport.
Authorization is usually provided ahead of time for the physical transport itself, and payment is usually authorized after the transport is completed and may be based on the documentation provided to substantiate the need for the transport itself, the team involved, and the mode of transport selected. This is vital for programs that serve multiple states by virtue of location or specialty service. For those who currently, or foresee, transfer and care of patients with out-of-state government sources of reimbursement, anticipatory negotiations can reap significant dividends for patients, families, and transport and hospital services and can increase efficiency of the entire process.Federal regulations protecting the right of patients to receive adequate emergency evaluation and care have been in effect for some time. It is important that transport personnel understand COBRA (Consolidated Omnibus Budget Reconciliation Act [Public Law No. 99-272]) and EMTALA regulations and requirements that must be met by referring and receiving facilities before a patient is transferred (see Chapter 7). Patients must be adequately evaluated in the facility from which they seek initial care, life-threatening conditions must be stabilized to the best of the providers' and facility's capabilities, and a facility that can provide an appropriate level of care for a patient's condition must be located and a receiving physician must accept care of the patient before transport to comply with EMTALA guidelines.
Stabilizing medical care for critically ill children must be provided regardless of the family's ability to pay or the patient's insurance status.