FARGO — Sen. John Hoeven is offering a legislative fix that would grant states the ability to exert some regulatory control over air ambulance services.

Hoeven, R-N.D., is working with Sen. Jon Tester, D-Mont., to offer a bipartisan amendment to a bill reauthorizing the Federal Aviation Administration.

Sen. Heidi Heitkamp, D-N.D., also working with Tester, is offering a separate amendment that seeks to study the issue to try to find a solution to the sky-high air ambulance bills patients sometimes are stuck owing.

The Hoeven-Tester amendment would allow states the authority to take action similar to a North Dakota law before it was rejected by a federal judge in Bismarck, who last month ruled the Airline Deregulation Act grants that authority exclusively to the federal government.

"Essentially, our amendment would allow state legislatures to do what the North Dakota Legislature did," Hoeven said.

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Much like the overturned North Dakota law, the amendment would allow states to create call lists that hospitals and emergency responders use to summon air ambulances. The lists would reveal whether the service accepts insurance payment in full for a ride, or bills patients for amounts not covered-which can be many thousands of dollars.

To qualify for the primary call list, air ambulance services must agree to accept major insurers' reimbursement as payment in full.

North Dakota's law was a legislative response to complaints from consumers who were stuck with high bill balances because of the gap in insurance coverage.

The North Dakota Department of Insurance last year compiled a list of 20 air ambulance bills that averaged more than $40,000 and left patients with average out-of-pocket costs of $24,514. The average payment from insurers was $14,925, or a little more than a third of the total bill.

"That was the issue the North Dakota Legislature was trying to address," Hoeven said.

The Airline Deregulation Act, passed in 1978, was intended to allow competition in air passenger service, allowing consumers to choose based on ticket prices, routes and schedules, said Rebecca Ternes, North Dakota's deputy insurance commissioner.

Today's extensive air ambulance system, with both helicopters and airplanes equipped with life-saving medical equipment, wasn't foreseen in the 1970s, when the act was passed, she said.

"This reaches all the states," Ternes said, adding that the National Association of Insurance Commissioners is helping to draft language for the amendment. "There's a lot of support for it."

Unlike people shopping for an airline ticket, most people who ride in air ambulances are either accident victims or very ill, being transferred from a small hospital to a major medical center, said Sen. Judy Lee, R-West Fargo, one of the supporters of the law that was overturned.

Those patients, or their family members, are not in a position-or in a state of mind-to ask the air ambulance crew about their insurance coverage, she said.

"This needs to be dealt with because this is overcharging at a difficult time," Lee said. "It has to be a bipartisan effort to do this."