This adventure is allotment of “Bill of the Month,” a Kaiser Bloom News/NPR crowdsourced investigation.
Kristina Cunningham was in abiding action on an black in June, back EMTs aerial her barrow into a medical flight, apprenticed for Boston.
The 34-year-old couldn’t use her appropriate arm or allege acutely afterwards a achievement six canicule earlier, and still had two claret clots at the abject of her brain. Cunningham’s dad, Jim Royer, remembers doctors at the babyish hospital in Wichita, Kansas, area Cunningham had abounding a ancestors wedding, adage she bare to see a neurosurgeon.
“There was altercation of aerial her to St. Louis, there was altercation of aerial her to Chicago, there was altercation of aerial her to Dallas,” Royer recalled, but “we don’t accept ancestors in any of those locations.”
So the doctors abiding to alteration Cunningham, via an Angel MedFlight Learjet, to Massachusetts General Hospital, area she would be diagnosed with a attenuate claret barge ache of the brain. MGH is about an hour from Cunningham’s home in Berlin, Massachusetts, and her 7-year-old son. Cunningham’s doctors and her insurer, CareFirst Blue Cross Blue Shield, based in Maryland, agreed the alteration was medically necessary.
“We affected it would be [covered],” Royer said, “because it was allegedly pre-approved by the insurer afore any flight took place.”
Royer says he and Cunningham didn’t anticipate about the Angel MedFlight allotment of her bloom alarm afresh until a letter accustomed in August. It was a one folio “explanation of benefits” with a jaw-dropping absolute in a cavalcade labeled “other amounts not covered.”
“When I got the bill for $474,725, I’m cerebration six or seven flights, and you can buy a accomplished new jet,” Royer said with a wry laugh.
That about half-million dollars is the absolute of four items, the better of which is a per-mile charge. That figure, $389,125, break bottomward to $275 a mile.
“It’s beyond than any abruptness medical bill I’ve alone seen,” said Chuck Bell, affairs administrator for the advancement analysis at Customer Reports. “It’s absolutely outrageous.”
In a abstraction aftermost year, Customer Reports abundant some of the affidavit badly aerial air ambulance bills accept become added common. Use of air ambulances is rising, as added rural hospitals close, babyish boomers age, and the use of telemedicine increases.
“The industry has absolutely developed by leaps and bound over the aftermost 15 years and prices accept angled or tripled,” Bell said. “Most of the operators of air ambulances now are for-profit, Wall Street-type corporations advertisement actual ample profits to investors.”
The Association of Air Medical Services (AAMS), a barter group, counters that it is not unique, that abounding hospitals and bloom insurers beyond the country are additionally for-profit and that some are owned by clandestine disinterestedness firms.
AAMS says a key acumen bills for patients with clandestine allowance affairs are generally aerial is this: Companies accept to accomplish up for the money they lose alteration added patients.
“Medicare pays about 60 percent of the bulk of the flight. Medicaid pays 35 percent or less. Self-paid patients pay a few cents on the dollar. And that has led to a crisis of actuality able to sustain the service,” Christopher Eastlee, AAMS carnality admiral for government relations, said in a statement, affirmation that he alone has bulk abstracts for emergency helicopter transports, not jets like the one in which Cunningham traveled.
In 2018, Medicare paid $8.65 per mile for a fixed-wing aircraft like the Learjet that transported Cunningham. That’s a abrupt adverse to Angel MedFlight’s $275 allegation per mile. There are no guidelines for free reasonable accuse in this case.
Cunningham’s insurer, CareFirst, initially paid $14,304.55, abrogation about $460,420 unpaid. In Massachusetts, a ground-based ambulance could not appeal that Cunningham pay the balance, as accompaniment law doesn’t acquiesce alleged antithesis billing. But air ambulances are absolute by federal aerodynamics laws. There are abundant cases of companies ambitious payments from patients. A few states accept approved to arbitrate but been unsuccessful, with courts adage that federal law prevails.
Cunningham has been focused on convalescent her accent and advancing for surgery. In January, she meets with her doctors to adjudge which blazon of anaplasty they acclaim for removing or bypassing the claret clots at the abject of her brain.
But Cunningham and her ancestor accept addition worry: what the mail may bring.
“I don’t know, we’ll see,” Cunningham said, with a shrug.
“It’s a big bill to be sitting out there apprehensive what’s activity on,” said Royer. “It would force her into bankruptcy.”
Angel MedFlight COO Andrew Bess told WBUR the aggregation is negotiating with CareFirst and will not appeal acquittal from Cunningham.
“We’re absolutely assured we’ll appear to a bright resolution admitting the insurer agreement the accommodating in the average of the dispute,” said Bess.
Royer said it was a letter from Angel MedFlight that articulate threatening. As he apprehend it, the aggregation told Cunningham she allegation assurance over the rights for Angel MedFlight to accommodate with CareFirst or accident actuality captivated accountable if the insurer did not pay. Cunningham active the request.
Bell, with Customer Reports, said agreeing to such agreement can be risky. Some air ambulance companies ask for abundant information about the patient’s claimed finances, advice they again use to actuate how abundant the accommodating can pay if the allowance agreement is accounted inadequate.
During inquiries for this story, CareFirst told WBUR it would access the proposed acquittal to Angel MedFlight. The insurer said it had credible an absurdity in its antecedent agreement to Angel MedFlight. CareFirst is now proposing to pay $70,864.90, or about one-seventh of the aboriginal charge.
“Unfortunately, absonant accuse like these by air ambulance providers are not uncommon,” said Scott Graham, a agent for CareFirst, in an email. “This is an affair because companies like Angel MedFlight about do not arrangement with bloom insurers on adjourned rates.”
WBUR forwarded this amend to Bess, who alleged it a “meaningful offer” in his emailed response.
“We accommodate a admired service, and for that providers should be adequately compensated and reimbursed,” Bess said. “We strive to assignment with our patients and apostle on account of them to get advantage appropriately owed to them beneath their allowance plans.”
Royer, a retired U.S. Air Force air cartage ascendancy systems manager, knows article about the bulk of operating jets. To him, it looks like Angel MedFlight aggrandized the bill, acquisitive the insurer would accede to a acceptable settlement.
“I assumption that the way things assignment nowadays, you ask for the moon and if you alone get a ample island, that’s what you get,” Royer said.
Bess responded to Royer’s affirmation in a statement.
“Staffing what is about an Intensive Care Unit at 30,000 anxiety presents different medical and aerodynamics challenges that may not be credible to those alfresco of the medical aerodynamics industry,” Bess wrote. “The bulk we accept per flight is a atom of the billed charge.”
Patients bent up in an air ambulance announcement altercation can book a complaint with the U.S. Department of Transportation.
A contempo advance for added austere federal announcement regulations was bare out of the Federal Aerodynamics Reauthorization Act, anesthetized in October. The legislation did authorize a board of industry representatives, including air ambulance providers and allowance aggregation representatives, amid others, to write and amend customer protections, including balance-billing practices. It did not add a claim for added amount and added abstracts accuracy alleged for in a Government Accountability Office report on the air ambulance industry.
The National Association of Allowance Commissioners says federal legislation is bare so that states can arbitrate to argue absurd air ambulance charges. Lawmakers from rural states, including Sen. Jon Tester, a Montana Democrat, said they’ll arouse such legislation.
The air ambulance barter accumulation says any such change would actualize “borders in the sky” that would baffle with life-saving air rescues beyond accompaniment borders.
Correction: An beforehand adaptation of this adventure misstated Angel MedFlight COO Andrew Bess’ title. We affliction the error.
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