Tuesday, November 29, 2016

Medical air transport bill staggers Ruidoso patient

A local business woman who said she was flown to Lubbock from the Lincoln County Medical Center earlier this year by a medical air service has joined the chorus of many other patients who received staggering bills for the transport and then were dunned for payment.

The air transport company, which operates under three different names in the Southwest, is the subject of as many as six class action lawsuits nationally over allegations of overpricing. In New Mexico, the company is involved in about a 22 legal actions, some as creditor, some as defendant and others as the plaintiff, a check of records on the state court website shows. The Internet features reports of litigation and accusations of overcharging in multiple states, one story included 13 pages of complaints under reader comments.

The local woman, who asked not to be identified, said she also contacted the New Mexico Attorney General’s office to lodge a complaint against the firm. A spokesman for that office would not confirm if a complaint was received or if the office is looking into the case.

“I had a heart attack in February (2016), went to the emergency room (at LCMC). They did an exam and told me that I needed to go to a cath lab (for a stent),” the local woman said. “They called around and I was told that all the cath labs in New Mexico were full and they needed to send me to Lubbock (Texas).”

Because she has New Mexico Health Connection medical insurance, Lubbock was out of her coverage network.

”I have the silver plan, which covers flight with a deductible of $100,” she said. “I asked them to stay in network as much as possible, but it wasn’t possible for heart surgery. I was flown down to Lubbock. They did everything they could at Presbyterian and took good care of me and got me out of there right away. My kids drove to Lubbock and got there at the same time I did (by air), and met me there.”

She signed something when she was put into the fixed wing plane, she said. In Lubbock, she had two stents put in and went home.

The woman said her insurance paid her surgery and hospital fees and everything but her deductible, even though the procedure was performed out of network, because it was necessary and nowhere within network was available.

“But when it came to the fight service, I started getting bills for $59,999 and they sent me this form, saying you need to sign this form saying that you will take care of whatever your insurance doesn’t or we can’t proceed to file for money from your insurance company,” she said. “It was worded as if I had to sign this form for them to even apply for reimbursement. So I did.

“At first the insurance company denied it. I appealed and then they paid $19,999, and I was told that was the maximum they would pay any in-network carriers, and (the insurance representatives said) that they had tried unsuccessfully to get this particular carrier, Rocky Mountain Holding Co., which goes under a lot of different names, Native Air and Air Methods, but are all the same company (to come under a medical care insurance network).”

She appealed for insurance to cover the rest of the bill, but was denied, then appealed again.

“We had a hearing. (insurance) had eight representatives there. They told me they thought the (bill) amount was outrageous and they have tried in the past to negotiate with this company and there is no negotiating with them. They had no interest in getting into network, because they know they can go after the patient for way above and beyond what the insurance would pay,” the woman said.

“I called the (air transport) carrier back and asked them if they would be willing to negotiate with my insurance company and they said sure. But my insurance company didn’t call them again and I have a feeling they wouldn’t have negotiated much.”

She said she called the air transport company one more time and asked, “Where do we go from here?

“They said we could negotiate this fee down some, but you need to send us some financial records, bank statements and that sort of thing,” the woman said. “I said give me a week to check. I looked them up and found out they have been all over the news (on major networks) basically for extreme collection processes to collect from patients after the insurance has been paid to them already and that this is a very common practice.”

While the Federal Aviation Administration governs the air-worthiness of the airplanes and helicopters, that agency does not regulate air fares. Neither does the New Mexico Pubic Regulation Commission, according to a spokesman.

“Because of the deregulation of air fares, it is not illegal for them to charge whatever they want,” the woman said. “But there is some sort of stopping point at $60,000, because that’s what they consistently have charged. It may not be illegal, but it certainly is unethical.

“Then they wanted to know what I could pay and I said, $1,200, which would put them over $20,000, There was silence on the other end of the phone. They have every intention to collect as much as possible, of course. They said, ‘Could you do that right now?’ I said no, give me a week or two. They haven’t contacted me since.  Maybe they have started a collection action. They don’t have to warn me about it. I told them if they can’t take that, they really need to do whatever they have to do. I can’t pay it and I won’t pay it.”

Air Methods Corporation is listed on the New Mexico Corporations website under the Secretary of State as active and in good standing with a formation date of Dec. 7, 1992, and corporate headquarters in Englewood, Colo. Rocky Mountain Holdings, LLC, is listed as a subsidiary, and as having withdrawn and not in good standing, but with an original registration date in New Mexico of Jan. 11, 1995. Native Air Company is referred to as a division of Air Methods. It is listed as active and in good standing in New Mexico with an organization date of March 9, 2000, and a corporation headquarters address in Los Lunas.

Christina B. Ward, Air Methods spokesperson, responded with this statement to an email requesting comment on the story:

“While Air Methods cannot comment on ongoing litigation, our mission is to provide critical emergency air medical service to communities and people whose lives depend on it, regardless of their ability to pay. We deploy whenever and wherever we are called by an attending physician or first responder, and after the emergency is over, our team of patient advocates work side-by-side with patients to navigate the complex and often frustrating process of seeking fair reimbursement from insurance companies. Balance billing is a last resort for us; we work with our patients to exhaust every avenue to get customary coverage from their insurance carrier. We strongly support addressing the root cause of balance billing by updating the drastic reimbursement shortfall by the government through Medicare and Medicaid, and encouraging insurance companies to negotiate with air medical providers in good faith. Without both, communities across the country are at risk of losing access to life-saving air medical services.”

The next question from the Ruidoso business woman is why LCMC officials are using the company.

“If it is so well known they are outrageous with their fees, and they have this horrid reputation with their collection processes, why are they being called and was anybody else called?” she asked. “I called the hospital and asked them those two questions.

She said she received a call back that the hospital chief of staff wrote a letter insisting the flight was necessary, but that wasn’t her question. “I asked who was called and who made the call,” she said, claiming she was told that person had left and there was no record of it.

“I’ve spent some time in the hospital and there is a record of everything,” the woman said. “That just didn’t sit well with me.”

Responding to a request for information about the hospital’s policy on arranging medical flights, officials at LCMC sent a statement pointing out that the LCMC is a critical access facility that serves Ruidoso and the county.

“At LCMC, we are committed to patient safety, which is why patients needing a higher level of care may be transported to a more appropriate facility. Depending on how quickly a response is needed, LCMC generally calls the closest transport company available. Transport may be provided by ambulance or air depending on the severity of a patient’s condition and proximity of the appropriate facility. It is our understanding that emergency services are generally covered by insurance companies regardless of network participation.”

Scott Annala, administrator of the county indigent healthcare fund, said he deals with two medical flight companies that have qualified to submit claims, but he hasn’t had a claim from either in years. They are Phi Medical Air based in Dallas and Native Air. But if a claim was submitted, his reimbursement cap under county policy is $2,000. He’s aware that the bills run much higher and said he has seen one at more than $70,000.

The local woman/patient said she received another letter from LCMC saying that Native Air is the only flight service in this area, the only one they ever called. “I called my insurance company and asked them for the names of companies that serve this area and they gave me two names.”

She filed a grievance with the state attorney general and heard back by phone within three days, she said. “They said that they have checked on the company and (Rocky Mountain Holdings) is not a corporation in good standing in New Mexico,” she said. “They should not be flying here. They are looking into Presbyterian about why they are calling this company.”

While Rocky Mountain is no longer a recognized corporation in New Mexico, Native Air and Air Methods both remain in good standing with the state. Air Methods is a publicly traded firm that reported annual revenues of $1.09 billion in 2015. According to reports, Air Methods Corp., the nation’s largest air ambulance company, listed at the Colorado Centennial Airport, in early November was hit with the sixth lawsuit since 2015 alleging it overcharges patients.

Source:  http://www.ruidosonews.com

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