Thursday, September 17, 2015

Man hit with $21,000 air ambulance bill

GRAY COURT, S.C. —Few people expect to be airlifted to the hospital. But when Roy Brown's wife, Linda Brown, had a heart attack in April, doctors said it was her best chance for survival.

"If it hadn't been for the helicopter, she wouldn't have made it to the hospital," Brown told WYFF News 4 Investigates' Tim Waller.

In April, Brown's wife broke out in a cold sweat and began to experience nausea. Brown believed she was having a heart attack, so he drove her to Hillcrest Hospital in Simpsonville.

"They said, 'She's having a major heart attack.' They gave her nitroglycerin tablets and IVs and all that," he said.

Brown said doctors insisted that his wife be flown to the emergency room at Greenville Memorial for lifesaving treatment.

Given the circumstances, Brown never thought to ask if the flight would be covered by his insurance company.  

"All I was thinking was whether she was going to survive or not," Brown said.

Survive she did, but that 12-mile flight cost $25,000. Her insurance paid $3,600, but the Browns received a bill from Med-Trans for the remaining $21,400.

"I was very shocked," Brown said. "I can't believe what they charged for that 10 to 15-minute flight. It was outrageous."

Linda Brown's insurance company only paid a fraction of the bill because Med-Trans, which owns and operates air ambulance services at Greenville Health System, AnMed Health Medical Center and Spartanburg Regional Medical Center, doesn't have provider agreements with insurance companies in South Carolina. Patients who are airlifted are always billed at the out-of-network rate.

"The helicopter that picked her up had GHS on the side of it, so I figured it was part of the hospital system, but it's not. That's like false advertising," Roy Brown said.

Blue Cross Blue Shield of South Carolina said it's tried many times to bring Med-Trans into its network. But officials said the for-profit air ambulance company has rejected each and every offer.

"We made what we believed was a fair offer for reimbursement. It was many times over Medicare, which is what Med-Trans accepts, and they elected to remain out of network, which we believe is harmful to the consumer," spokesperson Patti Embry-Tautenhan said.

Harmful, because the average Med-Trans flight bill was $35,000 in 2014, according to Medicare data compiled by Research 360. And the cost of those flights gets higher every year -- a 52 percent  rise since 2012.

And it's not just Med-Trans that has left some patients in a financial bind. Air Methods Corporation, whose LifeNet air ambulance service serves hospitals in the Columbia area, is being sued by a patient who was billed for nearly $31,000. The lawsuit claims Air Methods "conceal(s) their pricing structure by failing to enter into preferred provider contracts with managed care companies, and require(s) patients to pay the bill in full and seek reimbursement from their insurance companies."

"When you're laying on the side of the road and you get picked up, 'Thank you for coming to get me, but only charge me a fair price for doing it.' That's what this lawsuit is about," Columbia attorney Pete Strom said.

(Read the entire lawsuit against Air Methods Corporation here.)

Roy Brown claims the most expensive part of his wife's Med-Trans bill had little to do with the care she received.

"It cost $21,175 just for the helicopter to show up," he said.

WYFF News 4 Investigates contacted Med-Trans corporate in Lewisville, Texas, and asked why the company has no provider agreements with insurance companies in South Carolina.

"Our company is always willing to visit with any insurance company regarding rates," Med-Trans spokesman Reid Vogel said. "However, we find that insurance companies usually want to talk about Medicare rates that are unilaterally set by the federal government based on its own budget concerns, instead of being based on a reasonable, market-driven reimbursement level."

Vogel said 17 percent of Med-Trans' patients do not have insurance and have no way to pay. He said 22 percent of their patients have Medicaid, which pays less than $2,500 per flight, which is less than the 50 percent of what it costs to transport a patient.

"We basically lose large amounts of money on 40 percent of the South Carolina patients whose lives we save," Vogel said.

Two bills have been introduced -- one in the South Carolina Legislature, the other in the U.S. Senate -- to help cover the high cost of air ambulance flights.

In the meantime, families like the Browns struggle to pay for a service that saves lives.

"You've got a company in West Plains, Missouri, that I ain't never heard of and I owe them $21,000. To me, it ain't right," Roy Brown said.

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