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KXAN INVESTIGATES // On the night 20-year-old Byron Carter…
Updated: Thursday, 11 Nov 2010, 8:00 PM CST
Published : Thursday, 11 Nov 2010, 6:00 PM CST
AUSTIN (KXAN) - If you are in an accident, will your health insurance cover the costs? What if you have to be air-flighted to the hospital?
More and more consumers are finding themselves stuck with huge bills after being transported in a medical helicopter.
Private air ambulance companies are part of a growing industry . While medical helicopters can save lives, they come with a high cost. A cost many insurance companies won’t pay. Many consumers are unaware of it until they get the bills.
Last June, Oscar Vaz’s 12-year-old daughter fell and hit her head while at a Balcones Springs summer camp . Marble Falls Area EMS responded and requested an air ambulance be dispatched to the camp. Records show originally dispatchers called Travis-County-owned StarFlight . Minutes later, they contacted a privately owned medical helicopter, Air Evac , which has a base in Marble Falls -- dispatched, then canceled, StarFlight.
Twenty minutes later, Air Evac arrived at the camp, ready to whisk the girl to Dell Children’s Hospital .
Even though medical records show the girl's assessment scores were well within the normal range on all counts, she was loaded into Air Evac helicopter and flown to Dell. Her parents had no idea she was being air transported. When they arrived, much to their relief, doctors told them their daughter had no significant injuries and discharged her the same day.
“There was no trauma, no extended trauma to her and she could go back to camp and participate in pretty much any activity she wants,” said Oscar Vaz. An hour later she was back at camp.
Then the bill arrived. Vaz was stunned. It cost $16,355. The 31-mile flight took 17 minutes.
He began asking questions and said he kept getting conflicting information. When he finally got his daughter's medical records, he began to suspect that her situation wasn’t life threatening and perhaps, she did not need to be transported by air.
Vaz has driven the route between Austin and Marble Falls several times, so he was aware of the time required to make the trip. He compared the normal driving time to the time that elapsed between when EMS arrived at the scene and when the helicopter arrived at hospital.
“If EMS personnel at the scene had just started driving to Dell Children’s Hospital the minute they realized they needed to get her to the hospital, they’d have been at the emergency room long before the helicopter actually got there,” said Vaz.
He began to scrutinize the records closer. He wondered if an air transport was necessary.
He compared the decision to air transport based on the criteria set in guidelines published by the Centers for Disease Control and other standard operating procedure guidelines for EMS. He reached out to others in the industry.
“I’ve been able to contact three other medical trauma specialists in the field, people who work this industry, and I’ve been quite surprised that all three of them -- if they didn’t outright come out and say air transport wasn’t needed -- they’ve all said there are serious doubts on whether air transport should have been used in this situation,” said Vaz.
He acknowledged that it’s always easier to second-guess a decision made by responding paramedics on the scene, but said, “I think in my daughter’s case, she was inappropriately transferred.”
Vaz’s insurance company thought so, too. The company refused to pay the bill because it said the flight wasn’t “medically necessary."
Putting the issue of whether it was necessary aside, more and more consumers are finding themselves in a vulnerable position when it comes to whether their health insurance company will cover air transports. Some do, some cover only a percentage and some cap the reimbursement at $1,000 to $1,500.
It’s an issue that most consumers never think to consider.
“It’s perfectly reasonable for a consumer to expect that their insurance will cover them in the event of an accident, including the ride to the hospital that’s deemed medically necessary,” said Blake Hutson, a healthcare advocate with Consumers Union. “What we have here is consumers being squeezed between insurance companies with a low or maybe no reimbursement rate and a provider demanding payment for a high-cost service. Consumers may be left with tens of thousands of dollars in bills.”
The company that transported Vaz’s daughter couldn’t comment about her specific case due to patient privacy, but said patient care is always the primary concern. Andy Arthur, of Air Evac said consumers need to be aware of what their insurance will and will not cover. He said by being proactive and doing the research, consumers will be better equipped to consider options that will protect their families in the event of a serious accident.
Air Evac, like many private and non-profit air ambulance providers, sells memberships that can reduce the liability of the cost of medical helicopter transports, which can range from an estimated $10,000 to $22,000. The members' costs range from $49 per year to
just over $100, depending on the provider.
If a member needs to be air-transported to a hospital, the company agrees to accept whatever the insurance company pays, without seeking the balance from the member. But even a membership isn’t a guarantee.
Heidi McCord spent $150 to buy a three-year membership for her and her husband. They live in Kerrville.
“We bought it specifically because we live in a rural area. I travel to and from town, which isn’t far, but I know this is a dangerous highway out here and I just felt it could be something we may need,” said McCord.
She looked at it like and extra insurance policy.
“Absolutely, very much on the back of my mind as being something that I knew in an emergency situation vehicle crash, rattlesnake bite out in the middle of the country that help could be available to me,” said McCord.
Last December, she did need help. She was involved in a multiple-vehicle crash. One person died, several others were seriously injured. She was surprised to see two medical helicopters sitting side by side. She said she was alert enough to repeatedly tell responding paramedics, “I am an Air Evac member. I have a membership on Air Evac. I will only go on Air Evac.”
McCord was loaded into a helicopter and flown to a hospital in San Antonio.
“I’m thinking the entire way down there, on my way to San Antonio, praise, praise, praise for once in my life I have done something ahead of time that is going to benefit me. That I am not going to be saddled with this bill,” said McCord.
A few weeks later, McCord read an article in the Kerrville Daily Times about a neighbor who was shocked to get a bill for more than $19,000 from an air ambulance company called AirLife. The company is based in San Antonio and co-owned by Baptist and University Health Systems. The article described that despite his being a member of Air Evac, he was transported unknowingly by AirLife. He had no idea that there were two air ambulances servicing Kerrville. Neither did McCord.
McCord went through her medical bills and for the first time, realized that she, too, had been flown by a company other than Air Evac.
“I literally was sick,” said McCord. “I thought I was going to just lose it completely. I realized they did the same thing to me, after telling them repeatedly at the crash scene that I was a member and they still did not put me on the right particular helicopter. And both of them were sitting side by side and took off one minute apart from each other.”
The AirLife bill for the 49-mile trip from Kerrville to San Antonio was $16,325.30. McCord's insurance paid only $1,000 of the bill.
“I’m in shock, still,” said McCord. “Had I known they were putting me on the wrong helicopter and it would cost me $16,000-plus, I would have been clawing my way out of there.”
Memberships sold by the medical helicopter companies don’t guarantee their aircraft will always be available. If another company responds, the member is liable for the cost. If an insurance company deems the ride “not medically necessary," some memberships bill the members 50 percent of the cost of service.
It’s important to know what the terms and conditions are before buying a membership.
Several years ago, Air Evac started selling memberships in Kerrville. It appeared to be a win-win situation. The membership fees helped offset the cost of operating a medical helicopter service, while the community benefited from having a life-saving tool available.
But few people were aware that a second company had begun providing service, operating out of Sid Peterson Regional Medical Center. 911 dispatchers rotated the calls between the two providers. Members, who thought they were protected because they had an Air Evac membership, now had a 50-50 chance that the company they joined would respond to their emergency.
In February, a heated Kerr County Commission meeting publicly focused on the issue. The solution was for citizens to buy memberships in both companies. Kerr County Commissioners voted to offer payroll deduction for its employees to pay for the memberships in both companies. Even with memberships with both companies doesn’t carry a 100 percent guarantee if StarFlight or another provider responds to a scene.
“The average person cannot and will not be able to afford this, and their insurance will not pay for it and they will come after you and haunt you and take you to collections, and make your life miserable to pay these exorbitant amounts when you’ve already had one catastrophe in your life,” said McCord.
McCord and Vaz have little recourse. Air medical helicopters fall under the federal Airline Deregulation Act , so individual states have no power to pass any law regulating them. The Texas Department of State Health Services can require the emergency personnel aboard to meet certain requirements, but it has no power over where a company operates or how much it charges.
The rates vary from company to company.
StarFlight, which is owned by Travis County, bills at much lower rates. Its out-of-county base rate is $7,500 plus $85 per mile, while Travis County residents are billed at a base rate of $3,400 plus $85 per mile.
If StarFlight had not been called off on the night of Vaz’s daughter’s accident, his bill would have been $6,200 less.
“Most people get to choose what they buy. If it’s healthcare, you get to choose which health insurance plan you buy, you get to choose which doctor you go to. It’s one of the things we all I think we value in our system. Well, this is clearly the case where I had no choice. I wasn’t even given the choice at the time when my daughter was being picked up as to whether I would approve it or not,” said Vaz.
Vaz doesn’t know whether he would have consented to the ride. He was aware of the dangers of air medical transports. The FAA is currently proposing new safety regulations. The rules were prompted by an increasing number of fatal crashes of medical helicopters.
From 2003-2009, 84 medical helicopters crashed killing 77 people. At least 17 people have died in crashes involving air ambulances in 2010.
Therefore, anytime a medical helicopter is being considered the risk must be compared to any benefit.
Vaz said in his daughter’s case, the risk of flying wasn’t worth it because her condition wasn’t life-threatening and it didn’t mean getting to the hospital any sooner.
Air Evac’s representative, Andy Arthur, said patient safety is the only priority when deciding whether to transport by air. They rely on paramedics on the ground to determine the best course of action. While he couldn’t comment about the specific cases mentioned in this story, he said these situations are highly uncommon and that his company has never turned over a bill to a collection agency.
On Thursday, Vaz received notice from Air Evac that the company is reducing the bill by 50 percent because he is now considered "self-pay" because Vaz's insurance company would not pay any of the costs.