- The Washington Times - Saturday, August 10, 2019

ANALYSIS/OPINION:

Talk about surprise medical billing.

In April of 2008, my husband suffered a heart attack that required emergency medical helicopter transport from one local hospital to another. The bill for the helicopter trip was $12,000; after insurance, our out-of-pocket was a modest $2,000.

The times, they sure have changed, though. Not for the better.

In April of 2018, my son, a week into receiving his driver’s license, had a wreck that resulted in his helicopter air transport to a local hospital for a broken leg and for airbag shards in his eye. The bill for that helicopter trip was around $53,000. Auto insurance paid for $20,000; medical insurance paid for a bit — a very little bit. Initially, a less-than-$10,000 bit.

After working for weeks with the patient advocate for the helicopter company, then writing a letter to the CEO telling him I felt a “bit bamboozled” by the whole billing process because there’s no opt-in or opt-out when it comes to medical choppers, I was able to have the balance forgiven.



It took quite an effort, though. And wait, there’s more.

In January of 2019, my husband suffered another medical issue that led to his helicopter transport from one local hospital to another. The bill for this helicopter ride, provided by the same company that transferred my son in 2018, was $44,000. Now after insurance, the bill on my desk — the expected patient payment portion for this ride — reads $26,274. And 26 cents.

What’s worse, the pilot and co-pilot for this particular transport broke my husband’s foot while loading him in the chopper. Fighting for justice on this has proven fruitless.

Fighting this bill has proven time-wasting.

How can this be? 

My family’s hardly the only one in this situation.

“Air Ambulances,” Consumer Reports wrote in April of 2017, “Taking Patients for a Ride.”

The article continues, “Getting hit with a medical bill you thought insurance would pay is all too common. … The most frustrating part [about air ambulance bills], according to industry experts … is that many people taken by air ambulance could have been safely transported by ground ambulance.”

Yes. 

But let’s not blame the health insurance companies for this one. This is private helicopter medical transport companies, run amok with their nearly regulation-free billing power. The Airline Deregulation Act of 1978 bars states from regulating what air carriers charge. That’s opened wide the door for medical helicopter companies to bill patients large sums for dubious reasons.

For “medically unnecessary use,” as the National Association of Insurance Commissioners put it, in a report this August.

According to NAIC, between 2002 and 2008, the number of dedicated air ambulances in the United States rose from 400 to 800. Rotor & Wing International set the number somewhere between 840 and 960. Consumer Reports, meanwhile, estimated it at more than 1,000. Either way, HEMS — helicopter emergency medical services — pulls in more than $2.5 billion each year. And those are 2017 figures, reported by Rotor & Wing.

What’s going on?

Service providers are simply free to bill as they see fit. Some are being sued, as Bloomberg just reported, in its July piece, “Helicopter Bankruptcy Highlights Surprise Medical Bill Backlash.”

But for many families, the financial damage has already been done. Air transport companies have been making up the comparatively paltry amounts they’re allowed to charge Medicare and Medicaid patients on the backs of the privately insured, pretending it actually costs tens of thousands of dollars to fly someone 30 miles or so.

It’s called bilking, pure and simple.

The average charge from Air Methods, one of the nation’s largest HEMS provider, rose from around $13,000 in 2007 to $50,200 in 2016, Research 360 reported, in Consumer Reports. That, as Research 360 also found that the “real cost” of HEMS transport is around $7,000.

Patients, families of patients, are bluntly, getting financially screwed. Bamboozled, even.

The GAO in May reported about 69 percent of the 20,700 privately insured medical helicopter transport cases in 2017 were out-of-network. And while GAO didn’t analyze the size of the bills the average patient was left to pay, it did find this: “Air ambulances provide emergency services for critically ill patients. Relatively few patients receive such transports, but those who do typically have no control over the selection of the provider.”

Right-o.

For instance: Teenagers with broken legs at accident scenes can be transported by helicopter, rather than ground ambulance, without consent, without parental consent, without insurance company pre-authorization, with a simple decision of the responding emergency officials.

Same for husbands laying in hospital beds.

What of the idea of informed patient consent? The right of one to control one’s own health care?

Good questions. This is not capitalism; this is forced payment for imposed services.

In early May, President Donald Trump said, “We’re determined to end surprise medical billing for American patients.” A few days later, Vox wrote, “Congress is ramping up its push to stop surprise medical bills.” And a few days after that, Patient Responsibility News reported, “The healthcare industry has renewed its commitment to address surprise medical billing.”

That’s all well and good. A complete all-around, public-private partnership to bring about transparency and bring on the reasonableness regarding medical billing.

Love it. About time.

But let’s narrow eyes on the HEMS industry, too. Medical air transport companies have been far too free to run roughshod over the rights of privately insured individuals for far too long, leaving a wide swath of bankruptcies, financial fights and legal battles in their wake.

“Medical airlifts: Life, death and bankruptcy?” WJLA wrote in October, 2016.

There’s a headline that just shouldn’t be. Dear Mr. President, Dear Congress, let’s speed up the scrutiny on this and make sure protections are put in place to ensure patients, particularly the privately insured, aren’t faced with these dire outcomes in the future.

• Cheryl Chumley can be reached at [email protected] or on Twitter, @ckchumley.

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