Air Ambulances Not Subject to 8 Cal. Code Reg. § 9789.70(a)

It used to be that air ambulance services seeking to recover their expenses as a lien claimant in a California Workers’ Compensation case were limited to 8 Cal. Code Reg. § 9789.70(a), commonly referred to as the Official Medical Fee Schedule for air ambulance services. The Official Medical Fee Schedule is calculated at roughly 120 percent of the Medicare rate for all charges related to the date of service.

In a recent En Banc decision, the Workers’ Compensation Appeals Board held that an air ambulance service can recover the full extent of its billed charges in excess of the Official Medical Feel Schedule, provided that it can establish the following criteria:

(1)   It is a citizen of the United States undertaking by any means, directly or indirectly, to provide air transportation;

(2)   It is authorized to engage in foreign, interstate, or mail transportation by air as a common carrier, although it need not actually engage in interstate air transportation;

(3)   It is subject to regulation under the federal Airline Deregulation Act of 1978, 49 U.S.C.S. § 41101 et seq.;

(4)   The amount billed is a reasonable value of its services provided. For example, in this case $11,132.93 was found to be the reasonable value for air ambulance services when applicant was gored by a bull and was airlifted from his place of employment to a hospital over a distance of approximately 26 miles.

California’s Court of Appeal denied defendant’s petition for writ of review in the case of Zenith Insurance Co. v. W.C.A.B. (Enriquez, Luis, Dec’d, Enriquez, Cecilia, Applicant) (2nd—B256034). To date, no appeal has been filed with the California Supreme Court.