Lawmakers are pushing a bill that would require hospitals, before transferring a patient to another facility via air ambulance, to first call a carrier contracted with the patient’s health insurer in an effort to prevent excessive medevac charges.

The bill was spurred in part by a legal dispute between Kaiser Permanente Hawaii and Hawaii Life Flight, which does not have a contract with the health plan. Kaiser, the state’s largest health maintenance organization, has said that its members are getting stuck with exorbitant bills, with charges as high as $75,000 for a flight from the Big Island to Oahu.

“The patient is left with no recourse, but this huge bill. It’s not fair and it’s not right,” said Sen. Roz Baker (D, West Maui-South Maui), who introduced the bill.

States are prohibited from regulating medevac rates under the federal Airline Deregulation Act, passed in 1978, so air carriers are free to charge whatever they want.

Hawaii Life Flight is one of two Hawaii air ambulance companies that operate between the islands.

AMR Air Hawaii is the other carrier, and it charges thousands of dollars less than Hawaii Life Flight for similar flights, according to Honolulu Star-Advertiser research.

Kaiser has a contract with AMR to cover air ambulance services.

Some rural hospitals, including Kona Community Hospital on the Big Island, almost exclusively call Hawaii Life Flight to transport emergency patients, placing them at substantial financial risk, Baker said.

A Hawaii Life Flight bill for emergency transportation from Hilo to Oahu in December 2013 totaled $70,580, with a base rate of $16,441 and a charge of $219 per mile, or $54,139 in mileage costs. AMR said it charges a base rate of $14,000 per flight and $25 per mile, which would make the same flight about $20,000.

The measures lawmakers are considering — Senate Bill 1076 and its companion, House Bill 915 — are “for all the constituents who have been ripped off by practices over there (on the Big Island),” Baker said. “They should not have to pay those bills if they have insurance on another carrier. I’m sure Kona’s got some kind of sweetheart deal with them (Hawaii Life Flight). It’s not saving them (the hospital) money. It’s not improving patient outcomes. All it does is leave a tremendous burden on the patient who is forced to pay these enormous fees. Medical charges are exorbitant enough without having to layer on (these costs).”

Representatives of Hawaii Life Flight didn’t return calls for comment.

Kona Community Hospital CEO Jay Kreuzer said his facility regularly uses Hawaii Life Flight because it has helicopter service, while AMR transports patients using fixed-wing aircraft. Hawaii Life Flight can get patients to other hospitals quicker than AMR, said Kreuzer, who submitted testimony opposing Baker’s bill. The Kona hospital is a 30- to 40-minute drive away from the airport, and it can take four to six hours to put a patient onto a fixed-wing aircraft and transport him or her to a hospital on another island — as opposed to a helicopter that can get to the hospital’s landing site in eight minutes and to Honolulu in just over an hour, he said.

“We typically call Hawaii Life Flight first because they can get the patients to their destination quicker. From a physician’s perspective, if someone’s critical, our concern is getting them to the proper services as fast as possible,” he said. “We don’t deal with (costs). We just deal with what we need to do to treat the patient. That’s pretty critical if you have a heart attack. We don’t have cardiologists here. That’s the reason we do it. We don’t get paid anything for any of this.”

Baker disputed Kreuzer’s claims.

“That’s just absurd. It’s not going to take four to six hours,” she said. “The reality is that not all of the transports via helicopter are medically necessary. If there is an alternative service that is less expensive, that is less risky than taking a helicopter, that ought to be available, particularly if the patient has insurance.”

Speedy Bailey, general manager of AMR, said that generally, a fixed-wing aircraft can complete a transport from Kona to Honolulu in roughly two to three hours. AMR also operates the Maui Medevac helicopter as part of the Maui 911 EMS system.

Kaiser said in its supporting testimony to lawmakers that patients nationwide are struggling with “egregious” bills after being transported by an air ambulance. The HMO sued Hawaii Life Flight a year ago for funding patient lawsuits aimed at forcing Kaiser to pay what it calls excessive medevac charges. Kaiser’s complaint is related to a lawsuit against the health plan by Toby Sidlo, a tour boat captain who was flown to Oahu after falling into a beach bonfire in 2014 on Kauai. He is the lead plaintiff in a class-action suit against Kaiser, which paid 28 percent — or $14,000 — of his $50,000 air ambulance bill from Hawaii Life Flight, the Star-Advertiser reported in 2015.