EagleMed, LLC v. Travelers Insurance, 56 Kan. App. 2d 79

Summary

The Kansas Supreme Court held that the federal Airline Deregulation Act preempts state laws regulating the prices, routes, or services of air ambulance carriers, but does not itself require payment of air ambulance claims. The court concluded that Kansas workers compensation authorities may resolve billing disputes under the 2012 fee schedule, provided they determine whether charges are usual and customary in a manner consistent with federal law. The court reversed the Workers Compensation Appeals Board’s order requiring full payment and reversed the Court of Appeals’ direction to dismiss, remanding for factual findings.

Holdings

1. The Kansas Workers Compensation Act authorizes administrative resolution of fee disputes involving health care services provided to injured workers, including disputes concerning air ambulance charges, subject to federal preemption limits.
2. The 2012 Kansas workers compensation fee schedule requires air ambulance billings to be supportable by evidence that the charges are usual and customary; it does not automatically require payment of the carrier's full billed amount.
3. Applying the 2012 fee schedule is not necessarily preempted before the schedule is applied to the particular charges and the factual record shows whether the administrative inquiry imposes a substantive standard or has a significant effect on air carrier prices, routes, or services.
4. The Airline Deregulation Act does not itself require payment to air ambulance carriers providing services to injured workers; any payment obligation must arise from state law.
5. Federal Medicare reimbursement rates do not apply to the disputed air ambulance charges under the 2012 fee schedule.

Questions Presented

1. Whether the Kansas Workers Compensation Appeals Board had authority to resolve an air ambulance fee dispute under the 2012 fee schedule consistently with the Airline Deregulation Act's preemption provision.
2. Whether the 2012 Kansas workers compensation fee schedule required air ambulance billings to be supported by evidence that the charges were usual and customary.
3. Whether the Airline Deregulation Act required Travelers to pay EagleMed's full billed charges or otherwise imposed a payment obligation.
4. Whether federal Medicare reimbursement rates applied to the disputed air ambulance charges.

Disposition

reversed_and_remanded