The Roanoke Times, Va., Dan Casey column [The Roanoke Times, Va.]

Aug. 11--Some stories just won't die. The one about $22,000 to $32,000 medevac helicopter flights since Carilion Clinic switched contractors in 2012 is one.

Every day I'm getting calls and emails and letters from readers. Some fear if they're airlifted they'll face huge debts they can't pay, because the contractor, Med Trans Air Medical Transport, has no agreements with Virginia insurers and bills patients for the balance their insurance won't cover.

Others are continuing to call and write with other questions, information and their personal experiences. So here's some more about that still-broadening story, in a question-and-answer format.

Q: Can I refuse medical transport by helicopter?

A: There are two different answers to that one, and they don't exactly jibe.

One comes from Charles Drummond, a Vietnam vet who lives in Franklin County. It arose in April 2010, when Drummond, then 65, suffered what felt like severe indigestion while spreading mulch in his Glade Hill yard. He went to the emergency room of Carilion Franklin Memorial Hospital.

Drummond still isn't clear whether he was in the midst of a heart attack or close to having one. He said he was there for three to four hours while doctors did tests. They told Drummond he had blockages in some cardiac arteries, he said.

Then, "they told me that they were going to airlift me to Roanoke. I told them, 'No, I did not want to go by helicopter.' "

A little while later a crew member from the helicopter informed Drummond he was there to airlift him to Roanoke.

Again, "I told him no, I did not want to be airlifted," Drummond says. "He made some statement about me being in Vietnam and [I] shouldn't be afraid of helicopters.

"I told him that had nothing to do with it, that I would go by ambulance. I was put on the helicopter anyway."

Drummond said the total bill for the flight was $8,400, of which the portion not covered by insurance was a little more than $1,200.

Drummond was actually fortunate in one respect. The company that transported him was Air Methods, Carilion's previous helicopter contractor. Carilion did the billing under that arrangement, and had negotiated agreements with insurers. That may have kept Drummond's out-of-pocket costs much lower than they might be now.

Still, Drummond told Carilion that "I was not going to pay them for something that I did not ask for and did not want."

So Carilion sued Drummond in Roanoke General District Court. On Feb. 9, 2012, a judge found in favor of the hospital corporation. Including court costs, the judge ordered Drummond to pay $1,316 plus 6 percent interest from the date of the judgment.

The judge "said it was an emergency and that it had to be done and that if I had went by ambulance my family could have sued them," if he had died, Drummond told me Thursday.

Drummond said he spent the weekend in Roanoke Memorial Hospital and had triple-bypass surgery the following week. He says he's feeling fine today.

Carilion, Drummond said, is now drafting $25 each month out of his bank account. Carilion also has a pending action in General District Court to garnish wages from Drummond's part-time retail job. That case is scheduled for September.

Carilion spokesman Eric Earnhart had a different answer to the question, although he couldn't comment on Drummond's specific case because of patient confidentiality laws.

In general, "a patient who is awake, alert and oriented can refuse a medical flight. They will be advised that their choice could result in death or serious physical impairment," he said.

Patients are not flown unless they meet medical criteria as determined by hospitals and emergency medical crews, Earnhart said. Those are: that the patient requires continuing critical care during transport and/or that the time required for ground transport poses a significant risk to the patient.

"I sincerely hope no one chooses to reject a life-saving flight, resulting in death or long-term disability," Earnhart added. "We can (and will) work through the financial issues after the fact. The damage from an untreated heart attack, stroke or traumatic injury can't be undone."

Q: If I'm on Medicare and I'm transported by helicopter to Roanoke Memorial Hospital, will I be responsible for the balance of the bill that Medicare doesn't pay?

A: This question was raised by Fred Waddell, a retired Auburn University professor who lives at Smith Mountain Lake. In a phone call Wednesday, he told me he's heard it over and over from his retired friends and acquaintances.

They're scared, Waddell said, that they'll face huge and unanticipated bills for the portion of the helicopter transport that Medicare doesn't cover.

Ground and air ambulance transport, when medically necessary, is covered at 80 percent under Medicare part B. For that reason, Part B subscribers will face no more than 20 percent of the Medicare-approved rate for air transport.

That is typically far lower than the $22,000 -- $32,000 bills Med Trans has been sending patients with private insurance.

"Unless they have opted out of Medicare Part B, the most they could be stuck with is 20 percent of what Medicare says is the reasonable rate for the transport," said Albert Buford, a health care attorney from Rockbridge County.

Someone with a Medicare Part B supplemental policy will owe nothing, Buford said.

"Any balance billing beyond that should be referred to an attorney with knowledge of Medicare," he added.

Q: What can you tell us about Med Trans Air Medical Transport?

Several readers urged me to look into the air ambulance company Carilion contracted with beginning in February 2012. Here's what I found out:

Med Trans, which is based in Dallas, Texas, is owned by Air Medical Group Holdings, which is based in Boca Raton, Fla. Besides Med Trans, AMGH owns two other helicopter ambulance services: Air Evac Lifeteam, based in Missouri, and EagleMed, based in Kansas.

The company generated $561 million in revenue in the year that ended March 31, according to a Moody's Investors Service report issued in May.

According to that report, AMGH is majority owned by Bain Capital Partners, the private equity firm founded by Mitt Romney, the 2008 presidential candidate. (Romney's not involved in Bain Capital any more).

According to Moody's, as of April, AMGH was holding $790 million worth of debt they had incurred by selling bonds rated B1 and B2, which are essentially medium-risk junk bonds.

In May, the Moody's report noted, the company's indirect parent holding company, Air Medical LLC, borrowed another $200 million by selling junk bonds with an even lower -- and more risky -- rating, So in all, they're $990 million in debt.

The purpose of the most recent $200 million loan, Moody's reported, was "to fund a one-time dividend to shareholders."

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