Updated: November 22, 2019 05:44 PM
Created: November 21, 2019 04:15 PM
(WHEC) — If you find yourself in a situation where you need to be flown to the hospital, the last thing on your mind is how much the ride is going to cost, but when the bill arrives months later, even if you have insurance, you may be in for quite a shock.
You don’t call an air ambulance yourself. If you’re in a crash, it’s up to the emergency responders to decide whether it’s needed or if you get a rural hospital, the medical staff will determine if you need to be airlifted to a bigger facility. When they make that decision, they’re not looking at your insurance plan.
David Fultz was at work in the Village of Dundee when the excruciating pain in his left leg began. He went home to try and find some relief.
“I was on the couch, off the couch, put my leg in the shower, hot water, cold water just did not shake it,” he told News10NBC.
So, he drove himself to Soldiers and Sailors Hospital in Penn Yan.
“The woman said that we believe it's a blood clot, we're going to Mercy Flight you into Rochester and I said okay,” he said.
Staff at Soldiers and Sailors called his wife Beth to let her know what was going.
“When they're going to Mercy Flight you, you think of death,” she remembered thinking.
David was flown to Rochester General Hospital and rushed into emergency surgery. Thankfully, doctors were able to get to the clot in time, saving his leg and his life.
A month or so later, a bill for his Mercy Flight arrived.
It shows the base rate of his ride was $24,925 and then a $12,768 mileage fee was added, calculated at a rate of $266 per mile for the 48-mile trip.
“It was nuts, we just couldn't believe it was 38-thousand dollars for a trip, [..] I said... you've got to be kidding me,” David said after opening the bill.
The Fultz’s didn’t panic right away, they have insurance through Excellus Blue Cross Blue Shield so they figured the bill would be covered.
It turns out Mercy Flight Central is “Out of Network”—not only of Excellus’ network, but most other insurance networks too.
Basically, the insurer decides how much it is going to pay and the rest is up to the patient to pay. In some cases, insurers pay the full bill minus any copays and coinsurance but not in this case.
Excellus BCBS paid just $5,600 for David’s flight so now he and Beth are on the hook for the remaining $32,000 balance and recently Mercy Flight Central sent them a letter threatening to send them to collections if they didn’t start paying.
News10NBC Investigative Reporter Jennifer Lewke went to Mercy Flight Central to speak with CEO Jeff Bartkoski.
Jennifer Lewke: How do you even start explaining something like this?
Jeff Bartkowski: Well, I should say right off the top, we will fly the patient regardless of what their insurance is, regardless of their ability to pay.
Bartkowski says as a non-profit, Mercy Flight Central doesn’t get any state or federal funding and it hasn’t had much luck getting “In-Network” with most insurers because they can’t agree on a compromised reasonable rate.
Bartkowski: The vast majority of the time, we don't even generate enough flight revenue to pay our bills so it's not like we're... it sounds like oh my gosh, you guys must be racking up the money here, it's exactly the opposite.
Lewke: What do you say to patients who call you after their insurance has been run and still have a bill for more than $30,000?
Bartkowski: We say, okay... we're in a situation which we call balance billing, where we've said, we just can't accept what the insurance company paid or we won't be here next year, so what we do is significantly discount that bill right off the beginning.
But, Mercy Flight Central, still expects the patient to pay… so, back to the price:
Lewke: Why does it cost 25-grand just to step on the helicopter?
Bartkowski: It costs so much... if you realize the business we're in is medical and aviation, those are two very expensive industries to operate in…The crew is here at the hanger and ready to launch in 10 to 15 minutes, good days, bad days... a day that we fly three flights from here, a day that we fly no flights from here.
Lewke: Just a little to our west, the average cost of a flight was like $8,000 to $15,000... Why are you so much higher than that
Bartkowski: The rate is basically, we look at what our expected volume is for the upcoming year, we look at what our expenses are going to be and we try to come up with a rate, there's a bit of projection in there because it's not like you put an item on the shelf and that's the price—we don't even get half of what we charge typically.
In the Fultz’s case, Mercy Flight Central says it’s willing to take $10,000 and is offering a no-interest payment plan.
Jennifer Lewke: If you can adjust the bill at the end, how come you can’t do it at the beginning?
Jeff Bartkowski: because we should be paid by the insurance company at a reasonable rate at the beginning.
In a statement to News10NBC, a spokesman for Excellus Blue Cross Blue Shield said:
“Federal privacy laws prevent us from commenting on a specific individual’s case. In any case where a consumer doesn’t feel a claim has been properly handled, they have rights of appeal both internally at the health plan and externally. In NY, consumers have the right to have an outside independent expert review the matter and issue a decision which health plans abide by. There is no cost to the consumer and we would encourage consumers to exercise their rights to appeal. Air ambulance companies that refuse to contract with health plans and charge exorbitant rates are an issue for everyone across the country. It is one of the drivers of increasing health care costs for everyone.”
One thing is for certain, the back and forth between providers and insurance companies is an issue for patients across the country.
A man in California was charged more for his air ambulance ride than his lung transplant.
Bartkowski says while he and other providers continue to try and get “in-network” with insurers the industry is also working with state lawmakers on legislation that would essentially take the patient out of the middle, requiring insurance companies and air ambulance services negotiate rates with an independent third party. He says he’s hoping the legislation may be brought to a vote in the legislature in 2020.
For the Fultzs’, the stress of the bill isn’t helping with David’s continuing health issues.
“I got more problems than that right now to worry about. It makes me sick about the cost of that yea, but I've got more problems that I need to worry about,” he said.
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