Health Insurance only processed part of an emergency transport?

[u/Jumpy_Mud90]

Location: Colorado based services submitting claims to BCBS Wyoming.

My twins were delivered at 36 weeks via section in a small Colorado hospital. Both twins suffered pneumothorax, but one twin collapsed a lung and the small hospital was not equipped for her care. She was flown via fixed wing plane to Denver Children’s via Children’s hospital’s own emergency transport service. Since the fixed wing had to land off site, a ground ambulance had to transport her to the tarmac and from the tarmac. My insurance processed the flight as in network, but the ground leg as out of network. Even though the same company handled both. Insurance approved the transfer and approved the NICU stay at Children’s . I was told on the phone that if she would have flown via helicopter and landed on the roof of the hospital the entire transport would have been billed in network. The only reason she was transported via fixed wing was because she had to fly over the Rockies in March and inclement weather and even at that she had to wait 30 hours before any type of aircraft would leave the ground. I am being told the ground ambulance portion is not covered under the “No surprise billing” act but according to some googling, there is something called the “Prudent Layperson Standard” that may protect me? Any advice is greatly appreciated!

[u/throwfarfaraway1818]

Whoever is telling you its due to the No Surprises Act is correct. Air ambulances are covered under the act and ground ambulances are specifically excluded, so they are legally required to process the air ambulance claim as in network, but do not have to do so for the ground ambulance claim.