Saturday, November 05, 2016

Sky high air ambulance bills send patients into orbit: Air ambulance helicopters may save your life, but at what price? Much too steep, many families say

DALLAS -- Colton Lightfoot of University Park has had a few flips and spills on his motocross bike before. But the one the 17-year-old suffered last May on an East Texas track became a serious emergency.

"It was just right off the start, then crash, and then I got run over,” he said. “That's just what I've heard. I don't remember anything."

But his father Royston remembers everything.

“They got him on a flat board and stabilized him,” Lightfoot said.

He will never forget the drive to the nearby hospital in Sulphur Springs, the CT scan revealing a fractured vertebra, and a doctor's recommendation to transport his son by air-ambulance helicopter to a hospital in Dallas.

"Emotionally, you're a wreck,” Lightfoot said. “You see your son or daughter fly off in a helicopter, it's not good."

The family has video of Colton lifting off in the helicopter servicing the Sulphur Springs hospital. At the time, his parents were concerned about one thing -- the safety of their son.

Two weeks later, they were shocked when a bill arrived from the air ambulance company

"My wife said, ‘You are not going to believe this air ambulance bill,’” Lightfoot recalled. “We open it and it's $58,000.”

Their insurance carrier said it would only cover $15,000 of the 74-mile flight. The Lightfoots have to pay the rest, $43,000, on their own.

The air ambulance company, Air Methods, the nation's largest air ambulance company, was an out-of-network medical service provider. That means they didn't have a contract with insurance carriers with an agreed-upon price.

Air ambulance medical services in the U.S. are unregulated and that allows them wide discretion on charges. When Lightfoot Googled “Air Methods,” he found out he was not alone.

"I started reading through all these (complaints) and that's when the light went on… (they are taking advantage of) a loophole,” he said.

According to Dallas aviation attorney Ladd Sanger with the Dallas law firm Slack & Davis, the practice of billing out-of-network for air ambulance services is legal, but can be financially devastating for patients financially unprepared for the costs.

"The air ambulance companies, because they are called out in emergency situations, don't want to be in network with anybody because they don't want to have their fees capped at a reasonable and necessary level,” Sanger said.

Sarah Oelke of Oklahoma City remembers when her infant son, Garrett, was having trouble breathing hours after he was born.

"I was a little concerned,” Oelke said. “He didn't sound great."

He needed specialized care at Children’s Hospital at the University of Oklahoma Medical Center 11 miles away. An Air Methods helicopter assigned to Children's Hospital was recommended to transport her newborn.

"I'm not thinking anything about the bill to come,” Oelke said.

Her son turned out to be fine. But the $28,000 bill came due and has haunted her the past two years.

Insurance paid only $5,100, leaving her with a $23,000 tab. She says she will have to take out a loan to pay.

Oelke, a nurse practitioner, believes medical providers like Air Methods are wrong.

"Ethics, morals and informed consent are huge,” she said.

Oelke is just one of eight other Oklahomans suing Air Methods, accusing them in court documents of an "inflated pricing scheme and refusing to discount prices to those who have no ability to negotiate."

Her attorney, Alex Yaffe, is seeking class action status, saying there are hundreds of former patients across the U.S. who are being overcharged.

Another class action case alleging Air Methods overcharged patients is pending in South Carolina.

"It's expensive, but it can be done way less expensive, and way more efficiently than what's happening with these for-profit companies,” Yaffe said

Air Methods, and its parent for-profit company, Rocky Mountain Holdings, declined to comment on camera due to pending litigation, but provided WFAA-TV with this statement:

"We understand that every patient's individual, financial and health insurance coverage circumstances are unique, and our team is dedicated to partnering with every one of them. Air Methods has a charity care program in place to allow us to reduce patient financial responsibility. Our team is here to help.”

On the other end of the spectrum is Care Flight, a non-profit air ambulance operating in North Texas.

Medical Director Robert Simonson says between $12,000 and $15,000 per trip is a normal and reasonable fee. He says billing patients like Lightfoot for nearly $60,000 is questionable.       

"People are getting bills that are more expensive than their hospital bills once they got to the hospital,” Dr. Simonson said. “That begs somebody to take a look at the industry and say, ‘Is this appropriate or not?’"

If you are hit with an outrageous air ambulance bill, experts say:

Try to negotiate with the air ambulance service. Experts say the final tab could be an inflated number that may be negotiable;

If that doesn’t work, consult with an attorney who has both aviation and insurance experience.

File a complaint with the Texas Attorney General. You are likely not the only one receiving large bills.

Air Methods statement

"Our mission is first and foremost to preserve emergency air medical service for all communities around the country. Air Methods provides lifesaving care to more than 100,000 people annually. Much like a hospital emergency room, when we are asked to save a life, we deploy without regard to a patient's ability to pay. We understand that every patient's individual, financial and health insurance coverage circumstances are unique, and our team is dedicated to partnering with every one of them as they navigate through the post-flight and critical care process. Air Methods has a long-established charity care program in place to allow us to reduce patient financial responsibility within our legal parameters, and our team is here to help. 

"But other players in the healthcare system must also do their part. The drastically low reimbursements from the Centers for Medicare and Medicaid Services must be fixed. Air Methods strongly supports the  proposed federal legislation that would resolve the Medicare reimbursement shortfall by updating reimbursement rates. Insurance companies must also be willing to negotiate and start to reimburse for air medical transport services at a reasonable rate. A recent study conducted in Montana showed that for only a $1.70 more per month in insurance premiums, emergency air medical transportation can be reimbursed in full without burdening patients with medical bills.

"The core purpose of health insurance is to protect individuals from catastrophic events. Yet private health plans continue to shift toward high deductible, high out-of‐ pocket models, reducing coverage for their members. Emergency air medical transport and treatment is among the many crucial medical services where some health plans are seeking to limit or cut payments.

"We seek health plan partners across the table who are committed to quality and access. While many health plans continue to shrink the coverage they provide to their members, there are a few cases where we have been able to partner successfully with an insurance company. In a handful of markets, we have in-network relationships with health plans. These partners recognize the value of our lifesaving care, and offer coverage for emergency air medical transport and treatment that protects patients while paying rates that reflect the true cost of our lifesaving service and allow us to be financially sustainable. 

"Like all health care providers, if air ambulance providers are in-network with health plans, the payments received for care would be significantly decreased in the effort to incentivize volume. However, health  plans cannot in any way influence or drive volume for emergency medical transport. Thus, if health plans offer too low of payments for air ambulance providers to go in-network, they are left with the same number of transports with a drastically lower reimbursement for each. This impacts providers’ ability to invest in people, service and necessary equipment."

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