Tuesday, December 19, 2017

Injured doctor’s flight home proves costly for University of Vermont Medical Center

VTDigger 
News in pursuit of truth 

The company that flew an injured UVM Medical Center doctor home from the Dominican Republic uses modified Learjet 35 aircraft. Wikipedia photo

The University of Vermont Medical Center paid more than $250,000 for a hospital doctor to be flown home by air ambulance from the Dominican Republic earlier this year, according to sources.

A Florida-based medevac service sent the hospital an invoice for $536,000 for transporting the doctor, who was injured while on vacation, from the Caribbean country back to Burlington in late January.

The medical center’s CEO, Dr. John Brumsted, paid $38,135 at the time his colleague’s flight was booked, the sources said. In June, hospital officials directed that REVA, the Fort Lauderdale-based air ambulance service, receive an additional $218,116, bringing the amount paid to more than a quarter of a million dollars.

The status of the nearly $280,000 balance is unknown. The doctor who was transported told VTDigger that REVA has not sought personal payment of the balance.

Initially, top hospital officials told VTDigger they were unaware of any large air ambulance claims, but later amended their answers and acknowledged a large payment had been made. They declined to comment further, citing medical privacy. An official with the air ambulance company also declined to comment about the status of any balance due.

VTDigger is not identifying the doctor, who requested medical privacy. The doctor and other sources described the injuries as serious. The doctor said the injuries required care not available in the Dominican Republic “as soon as possible.”

The doctor confirmed to VTDigger not knowing the flight would cost more than $38,135; sources indicated the doctor and Brumsted both said they would have canceled the flight if they’d known what the REVA invoice would be. A hospital spokesperson said the doctor had to cover a portion of what the hospital paid and described the amount as “substantial.”

“We are still working out the details of this very complex situation,” the doctor said by email.

In an interview with VTDigger in November, Brumsted and hospital senior legal counsel Spencer Knapp initially said they were unaware of any large air ambulance payments made by the hospital. Medically necessary flights are a covered health care benefit for employees at the hospital, which is self-insured.

Two days after the interview, a hospital spokesperson said Brumsted and Knapp had “reflected” on the interview and wanted to provide “a more accurate answer.” They then acknowledged a large payment had recently been made.

According to sources, Brumsted signed an agreement with REVA to transport the doctor from the Dominican Republic to Burlington on Jan. 30, after receiving a “quote” for $38,135, which Brumsted thought was the full cost of the flight. Sources said Brumsted paid with his American Express card and was later reimbursed by the hospital. However, the contract amount apparently was only a retainer; the agreement called for charges of $122 for every air mile.

After transporting the doctor home, REVA sent the hospital an invoice on Jan. 30 for $536,000, billing for more than 4,200 air miles. The medevac company charged for flying from its base in Fort Lauderdale to the Dominican Republic, then to Burlington and back to Fort Lauderdale, a method of billing that is standard industry practice.

Fort Lauderdale to the Dominican Republic is more than 800 miles; the Dominican Republic to Burlington is almost 1,800 miles, and the return trip to Fort Lauderdale is about 1,300 miles. (No explanation was given why REVA charged for several hundred additional miles.)

REVA bills itself as the biggest air ambulance service in North America and offers emergency and non-emergency medical transport. The company has a fleet of 19 jets, including 14 Learjets modified and “configured and staffed to resemble a self-contained critical-care unit,” according to the company’s website.

In June, after reviewing the bill, the UVM Medical Center’s Human Resources Department determined the hospital’s insurance plan typically covered medically necessary air transport to the closest hospital. Based on that opinion, the department directed the hospital’s health insurance administrator to pay $218,116 to REVA — the cost of an evacuation to Fort Lauderdale, which medical center officials determined would have been the closest U.S. hospital.

The UVM Medical Center uses Blue Cross Blue Shield as administrator of its self-insurance program. When a company is self-insured, it assumes the financial risks for health insurance benefits, typically with a third party processing the claims.

Sources said Knapp told skeptical colleagues that Blue Cross had not raised any questions and maintained that Blue Cross had “stupidly” paid REVA the $218,116, despite the direction given by the hospital Human Resources Department. Brumsted, the sources said, was unaware of the June payment to REVA until after it was made.


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