FARGO-North Dakota legislators-reacting to consumer bills averaging almost $60,000-have passed a law that will restrict charges by air ambulance services that are not participating providers with major insurers.

Once the provision takes effect on Jan. 1, non-participating air ambulance services will be allowed to charge only the average of participating services.

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Senate Bill 2231, which Gov. Doug Burgum signed into law on Tuesday, April 18, was a response to patients being hit with staggering bills, averaging $59,287, for air ambulance transports from services that were outside their insurance networks.

"We've seen a spike in complaints," said Insurance Commissioner Jon Godfread.

Insurance doesn't cover the cost of an air ambulance when the ambulance provider doesn't have a contract with the patient's health plan, what's called an "out-of-network" service.

The North Dakota Insurance Department received 28 complaints totaling $1.66 million from consumers for air ambulance services from 2013 through January 2017.

Those figures reflect the increasing use of air ambulance services in North Dakota, Godfread said. Patients are at a disadvantage because they often require trauma care from an accident or are seriously ill, he said.

Also, for non-emergency transfers, effective Aug. 1, hospitals will be required to notify patients whether their air ambulance service is in or out of the patient's insurance network.

"These consumers did not have the option or ability to choose their provider, and now because of the choices made by someone else, are left facing bankruptcy," Godfread said.

The law also will ban, effective Aug. 1, what Godfread described as subscription services certain air ambulance services sold to counties to prevent what are called "balance billing" for patients for out-of-network air transports.

Those subscription fees, paid by about 13 counties, mostly in western North Dakota, ranged from $2,000 to $50,000, Godfread said.

Sen. Judy Lee, R-West Fargo, was the bill's primary sponsor, and has long sought a legislative solution to steep, out-of-network air ambulance bills.

"It is important to protect citizens in critical medical situations from unexpected high costs beyond what insurance covers," she said in a statement. "It is also important to keep this issue visible to the federal government."

North Dakota passed legislation in 2015 that sought to restrict air ambulances by creating a primary air ambulance carrier list. In order to get on the list, air ambulance services effectively had to agree to become participating providers with Blue Cross Blue Shield of North Dakota, meaning they would have to accept the insurer's reimbursement as full payment for a flight.

A federal judge rejected the law in 2016, ruling that the state overstepped its authority.

The new approach, because it regulates the insurance coverage of air ambulance services, is squarely within the state's regulatory authority, Godfread said.

"We've got some arguments we can make, should we be challenged in court," he said.