KANSAS CITY, Mo. (AP) — Sick or injured Missouri residents who need air ambulance services face thousands of dollars in bills and sometimes aggressive collection efforts if they cannot pay, according to a state report.

The average bill after insurance for people who needed air ambulances in 2017 was $20,000, the Missouri Department of Insurance, Financial Institutions and Professional Registration said in a report issued Tuesday.

The report found one patient who was billed $25,000 after getting kicked by a horse and another billed $100,000 after being transferred out of state for treatment of encephalitis, KCUR reported .

Air ambulance companies billed Missouri residents nearly $26 million for services in 2017, leaving patients responsible for $12.4 million after coinsurance, copays and deductibles. That is about $20,000 per individual, said Angela Nelson, director of market regulation at the insurance department and leader of the team that produced the report.

“That’s kind of a jaw dropper to us in terms of how much we’re talking about,” Nelson said.

The report found that insurance companies can’t negotiate prices with many air ambulance services because they are not “in-network” providers.

It also found many air ambulance companies use collection practices such as placing liens on homes or garnishing wages if patients are unable to pay the bills. Nelson’s team found 184 Missouri court records since 2012 involving lawsuits by air ambulance companies, with most collection actions.

Medicare reimbursement rates for air ambulance services range between $3,368 and $6,404 and Medicaid reimbursements average $2,253. In contrast, private health insurers were billed an average of $41,321, of which they paid an average amount of $23,087, according to the report.

A statement from the Association of Critical Air Transport, comprised of air and ground ambulance providers, said the group was concerned about the exorbitant bills. The group supports federal legislation to improve consumer protections for air ambulance patients and to amend the Airline Deregulation Act so states are allowed to regulate air ambulance prices.

Air ambulance companies say their prices are dictated by high fixed costs and the need to offset low reimbursement rates from Medicare and Medicaid. A U.S. Government Accountability Office report in 2017 found one company said operating a single air ambulance helicopter requires a staff of 13 – four pilots, four nurses, four paramedics and a mechanic – in order to maintain the ability to deploy at any time.

The report also noted that air ambulance providers are not subject to the price competition because patients have no say in how and by whom they’re transported and can’t avoid out-of-network providers.

Nelson said her agency can’t do much to lower prices other than respond to consumer complaints. Since 2013, it has received 128 complaints or questions about air ambulance services, she said, and in 23 cases the department helped recover a total of $560,000.

TOPEKA, Kan. (AP) — Authorities have found a missing 70-year-old man dead with his dog at his side after his pickup truck became stuck in the mud in rural Kansas.

Dannie Smith, of Topeka, hadn’t been seen for five days when his body was found Wednesday afternoon on a low-maintenance road in Jackson County, near the Shawnee County line.

Jackson County Sheriff Tim Morse says Smith was known to drive to the reservation in Jackson County to purchase cigarettes. Morse said Smith was reported missing Sunday because he hadn’t been seen since Friday. An autopsy is planned.

His chocolate Labrador retriever, named Bear, was determined to be in good health.

KANSAS CITY, Mo. (AP) — Records show there have been dozens of wrecks on a northern Kansas City road where a 4-year-old was killed.

Data from the Missouri State Highway Patrol shows there had been at least 43 crashes since 2009 within the roughly one-fifth of a mile stretch of Northeast Parvin road where the girl was killed Monday.

The girl died when the sport utility in which she was riding went off the road, struck several trees and overturned. Records show a longer stretch of the road has seen at least 173 accidents in the last decade.

Public records show that Kansas City’s Public Infrastructure Advisory Committee has been petitioned at least four times since 2014 for funds to improve the road. Each was rejected.

By JIM MCLEAN

As President Donald Trump prepared to address the nation about the partial shutdown of the federal government, U.S. Sen. Jerry Moran huddled with staffers this week talking about rocket launches.

They fretted over whether the furlough of workers at NASA and the Federal Aviation Administration could force the delay of satellite and experimental rocket launches.

That shutdown also delays a planned Senate vote on the U.S. Mexico Canada Agreement, or USMCA, the North American Free Trade Agreement replacement negotiated by the Trump administration.

“Getting those answers isn’t easy because the people who normally answer me and my staff’s questions aren’t at work,” Moran said told the Kansas News Service.

Moran, a Kansas Republican, chairs the appropriations subcommittee that handles the budgets of NASA, the Office of the U.S. Trade Representative and scores of other agencies.

He said trade negotiations with the Chinese appear headed toward a conclusion, but staffers supporting the U.S. officials conducting the talks fall among the ranks of furloughed federal workers. The same is true, he said, of workers at the FAA and NASA who license and schedule launches of experimental rockets and those carrying new satellites into orbit.

One of the missions likely delayed by the shutdown is a planned Jan. 17 launch of an unmanned capsule to the International Space Station by SpaceX, a company founded in 2002 by entrepreneur Elon Musk.

The shutdown has also halted work at the U.S. Department of Commerce on two reports that Congress needs before the Senate can vote to ratify USMCA.

“This will delay our ability to consider a trade agreement that is of significant importance to Kansas,” he said. Mexico and Canada are the top two purchasers of Kansas farm and manufacturing exports.

Beyond those specific issues, Moran said he’s concerned that the shutdown will make it harder for the federal government to recruit the kind of workers it needs, particularly those with technical skills such as cybersecurity.

“They’re in great demand,” he said. “Many of them are very important to our national security.”

But he said when the government can’t guarantee those people will be paid, “they start looking for work elsewhere.”

Ending the stalemate will require compromise on all sides, Moran said. That could mean a deal that gives the president the additional money he’s demanding for border security — including a wall — in exchange for broader immigration reforms. Those could include renewing protection for immigrants covered by the Deferred Action for Childhood Arrivals, or DACA, who face potential deportation after being brought into the country illegally as children.

“That is something we could go to that I think would bring Republican and Democrat support,” he said. “The question is: Would it be something the president would sign?”

Negotiations prove even harder, Moran said, when two sides can’t agree on key facts.

Trump’s speech from the Oval Office drew criticism for its characterization of a border “security crisis.” Leading up to the speech, administration officials made disproven claims that thousands of terrorists are sneaking into the country from Mexico.

“We need to get to the point in this country where facts are agreed to and they don’t change from one day to the next,” Moran said. “We can have the negotiations, but those negotiations can only be successful if we’re all talking about the same set of facts.”

Other members of the state’s congressional delegation continue to defend the president’s claims.

Tweeting after Tuesday night’s speech, Republican U.S. Rep. Ron Estes said the president made a clear case for “why we need to address the crisis on our southern border.”

“Democrats must come to the table to negotiate a solution to protect our border and reopen government,” Estes said.

Moran agrees border security is a priority, but he said the threats extend well beyond the U.S. Mexico border.

“It’s all of our borders,” he said. “It’s our ports of entry. It’s our coastline.”

Jim McLean is the senior correspondent for the Kansas News Service. You can reach him on Twitter @jmcleanks. 

JEFFERSON CITY, Mo. (AP) — The Missouri General Assembly began its historic 100th edition on Wednesday with a new slate of leaders who touted an agenda focused on promoting good schools and good jobs.

Republicans in charge of the Capitol also encouraged a more peaceable assembly, a year after a gubernatorial scandal and a chain-reaction of resignations resulted in widespread upheaval among those guiding the state.

This year, one of the most contentious proposals could be a GOP-led attempt to undo parts of a new voter-approved constitutional amendment that changed the way legislative districts will be drawn after the 2020 Census. The measure could increase Democrats’ chances of winning seats, which hasn’t set well with majority-party Republicans.

About one-third of the lawmakers are new for the 2019 session, replacing incumbents who either could not run again because of term limits or chose not to do so. But the partisan composition of the House and Senate remains virtually unchanged after November’s elections.

Senate Republicans hold a 24-10 majority over Democrats. House Republicans hold a 115-47 majority over Democrats with one vacancy. Republican Scott Fitzpatrick is to be sworn in as state treasurer next Monday instead of serving the legislative term to which he won re-election.

On a largely ceremonial first day, new lawmakers took the oath of office and then elected Republican Rep. Elijah Haahr as House speaker and Republican Sen. Dave Schatz as Senate president pro tem. Both replaced leaders who were prohibited by term limits from continuing to serve in the Legislature.

Haahr promised that lawmakers “will create bold solutions for the challenges” facing Missourians, including those trapped in opioid addictions or what he described as “a broken criminal justice system.

He said lawmakers would fully fund public schools for the third consecutive year and laid out a goal of ensuring every child “gets a world-class education.” Haahr later told reporters he didn’t have specifics yet on how to accomplish that, but he added: “education is an area we will probably spend a lot of time on this year.”

Schatz said lawmakers also must work to “reduce the burden of government” by promoting reforms to taxes, regulations and lawsuit procedures.

Missouri has undergone a significant political reshuffling since lawmakers last met in regular session.

Republican Gov. Mike Parson was lieutenant governor at this time last year. He took over as chief executive June 1 when Republican Gov. Eric Greitens resigned while facing potential impeachment over allegations of sexual and political misconduct.

Since then, Parson has appointed former state Sen. Mike Kehoe as lieutenant governor, former state Treasurer Eric Schmitt to take over as attorney general following Josh Hawley’s election to the U.S. Senate, and Fitzpatrick to take over as treasurer.

Parson has said he wants to focus on workforce development and infrastructure. But that latter goal will be complicated by the fact that voters in November rejected a proposed gas tax hike that would have raised hundreds of millions of dollars for roads and bridges.

Voters in November also approved a minimum wage increase, legalized medical marijuana and adopted new ethics policies for lawmakers.

House Minority Leader Crystal Quade said that by passing progressive ballot initiatives and electing a conservative majority, Missouri voters showed they aren’t party loyalists and prefer balance in state government. Quade said Democrats are committed “to defending the will of Missouri voters” against efforts to rollback ballot measures.

Though they made no mention of it in their opening day speeches, Republican leaders have said they would like to revise a new constitutional amendment that changes Missouri’s criteria for redrawing state legislative districts. The measure creates a new position of nonpartisan state demographer to draw districts aimed at achieving “partisan fairness” and “competitiveness.”

Senate Majority Leader Caleb Rowden told reporters Wednesday that the new redistricting provisions are “terrible policy.”

Any changes would have to be referred back to voters in the form of another constitutional amendment.

The first day of the legislative session included a rare joint session of the House and Senate in order to take a group photo commemorating the start of the 100th General Assembly. The Legislature’s terms are numbered in two-year increments, and Missouri is approaching the 200th anniversary of gaining statehood in 1821.

OLATHE, Kan. (AP) — The former owner of an Olathe barbecue restaurant was sentenced Wednesday to serve one year and one month in prison for using customers’ credit cards to fund spending sprees.

Matthew Sander, former owner of Smokin’ Joe’s Bar-B-Q, pleaded guilty in November to seven counts of identity theft, four counts of theft and one count of criminal use of a credit card.

Court documents filed by Sander’s attorney say he had a “significant drug and alcohol problem” that he has since addressed.

Prosecutors said Sander went on spending binges with credit cards that customers left behind at the restaurant. In one case, Sander used a debit card from a purse he took at an Overland Park restaurant.

Sander was ordered to pay restitution of $11,400.

LIBERTY, Mo. (AP) — Two Missouri Department of Transportation workers were injured after a car struck one of them and a maintenance truck in northwest Missouri.

The Missouri State Highway Patrol says the collision happened Wednesday morning on a rural road in Clay County.

The patrol says a car hit a worker who was standing behind the maintenance truck. The state transportation department says the worker was pinned under the vehicle until crew members were able to move it.

A worker inside the maintenance truck was injured when the car hit the truck.

Both workers were taken to a hospital with injuries that were not considered life-threatening.

The driver of the car suffered minor injuries.

The cause of the crash is under investigation.