Under ERISA, Air Evac seeks equitable relief, namely an injunction and reformation of Arkansas Blue’s insurance plan terms “so that they do not include limits on benefits for emergency air ambulance transportation.” The district court concluded that Air Evac did not have the right to seek equitable relief under ERISA. “To survive a motion to dismiss, a complaint must contain sufficient factual matter, accepted as true, to ‘state a claim to relief that is plausible on its face.’ ” Id. 12(b)(6) de novo, “accept the well-pled allegations in the complaint as true and draw all reasonable inferences in the plaintiff’s favor.” Meiners v.

We review a district court’s grant of a motion to dismiss under Fed. These laws do not provide a private cause of action, however, so Air Evac has chosen to seek relief under the Employee Retirement Income Security Act of 1974 (“ERISA”), the Arkansas Deceptive Trade Practices Act (“ADTPA”), and contract law. (To effectuate appeals, Air Evac obtains assignments from patients of their right to appeal coverage decisions.) Neither option has proved very successful.Īir Evac argues that Arkansas Blue’s limited reimbursement for air ambulance services violates a number of federal and state laws, including laws that prohibit annual limits on “essential health benefits,” laws that mandate minimum payments for certain emergency services, and laws that require adequate provider networks. According to the Amended Complaint, Air Evac has two options for making up such shortfalls: balance-bill the remaining cost to the plan member or appeal to Arkansas Blue. Thus, when Air Evac provides air ambulance services to Arkansas Blue plan members, it is regularly compensated less than it charges. Moreover, Arkansas Blue’s insurance plans typically limit reimbursement for air ambulance services to $5,000 per trip, though in some cases reimbursement is limited to $1,000 or less. For instance, Arkansas Blue, as a matter of policy, does not contract with air ambulance providers, and therefore has no in-network providers of air ambulance services.

But most government and private insurers provide only limited reimbursement for air ambulance services. Federal law requires Air Evac to provide its services without regard to a patient’s ability to pay, which means Air Evac relies heavily on government and private insurers for reimbursement. With a per mile charge of between $115 and $205, Air Evac’s average actual charge for air ambulance transportation in 2014 was over $30,000. Air Evac’s base rate for a single transport in 2014 was $19,250.

We affirm.Įmergency air transport is expensive. The district court 1 dismissed all of Air Evac’s claims for failure to state a claim under Fed. (“Air Evac”) asserts numerous claims against USAble Mutual Insurance Company, d/b/a Arkansas Blue Cross and Blue Shield (“Arkansas Blue”), regarding Arkansas Blue’s allegedly inadequate reimbursement for air ambulance services that Air Evac provided to Arkansas Blue plan members. Rather, Jr., of Little Rock, AR.Īir Evac EMS, Inc. The following attorney(s) appeared on the appellee brief Chet A Roberts, of Little Rock, AR., Gordon S. Counsel who presented argument on behalf of the appellee was Anthony F. Poynter, of Little Rock, AR., Alex T Gray, of Little Rock, AR., Jeremy Y Hutchinson, of Little Rock, AR., George Nathan Steel, of Little Rock, AR. The following attorney(s) appeared on the appellant brief Scott E. 18-2264 Decided: July 23, 2019īefore BENTON, MELLOY, and KELLY, Circuit Judges.Ĭounsel who presented argument on behalf of the appellant was Henry C. USABLE MUTUAL INSURANCE COMPANY, doing business as Arkansas Blue Cross and Blue Shield, Defendant - Appellee No.

United States Court of Appeals, Eighth Circuit.ĪIR EVAC EMS, INC., Plaintiff - Appellant v.

Air evac insurance