How much could you be charged if you take an air ambulance? For sure, many times what it actually costs. Julie Appleby reports for Kaiser Health News on a man who was charged $489,000 for his air ambulance ride. How do you protect yourself from such insane charges?
Medicare and other health insurers should cover air ambulances when medically necessary. The question becomes what is medically necessary. Because they cost so much, it is in the corporate insurers’ financial interest to claim that air ambulance rides are not medically necessary.
Appleby’s story profiles a 32-year old man, Sean Deines, who fell gravely ill while in rural Wyoming. He had a low white blood cell count, which turns out to be acute lymphoblastic leukemia. He needed emergency care, for which he was airlifted to the University of Colorado hospital. His insurer, Blue Cross Blue Shield of North Carolina, through his state health insurance exchange, covered that trip.
After Deines is stabilized, he and his wife decided to get care at Duke University Medical Center, his in-network hospital in North Carolina, where his family resides. The air ambulance company they contacted, Angel MedFlight, said it would accept payment from his insurer, and he would have no responsibility for the cost.
Notwithstanding representations from the air ambulance company to the contrary, Deines received a bill for $489,000, About $70,000 of the bill was for ground ambulance services in Denver and Raleigh-Durham. But, Deines’ insurer claimed this transport was medically unnecessary; he could have remained in Denver for 28 days of treatment to put his cancer in remission.
The air ambulance company tried to get prior authorization from Deines’ Blue Cross plan, but it transported Deines before it had approval. After Blue Cross denied the service, Angel MedFlight appealed, which resulted in a check to Deines from Blue Cross for $72,000, covering a small portion of his services, which Deines forwarded to Angel MedFlight.
Three months later, Blue Cross demanded its money back, saying it had paid the $72,000 in error. It ended up sending the debt to a collection agency. Angel MedFlight appealed again to an outside independent evaluator who ruled for Blue Cross, claiming that Deines could have stayed at the Colorado hospital.
What can you do to protect yourself from an air ambulance and ground ambulance bill of this magnitude? Shop around. Recently, I helped a family member get from a hospital in Arkansas to a hospital in New York. The total charge for the air ambulance and the ground ambulances from and to the hospitals was under $20,000, a far cry from $489,000. It’s also a good idea to call your insurer to understand its coverage policy. But, it’s not likely you would know ahead of time whether the insurer would pay for the service or deny coverage on medical necessity grounds.
NB: As of January 1, 2022, air ambulances must tell you the cost of their services ahead of time. The federal No Surprises Act should protect you from being charged anything more than what your insurance pays a network provider; it should also ensure you are told what your costs might be if your care is denied.
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