Sky-high bills for medical copter flights must come down

Morning Call (Allentown, PA)

April 23--If you survived a traumatic injury or illness because you got to a hospital in time after being flown there in a medical helicopter, you surely appreciated the ride.

If you got a heart-stopping bill afterward, you may not have been so appreciative about that. Air ambulances, a common sight in the Lehigh Valley with our trauma centers, are expensive and the funding system isn't fair for anyone involved.

Helicopter operators lose money flying patients on Medicare and Medicaid because those government insurance programs don't pay anywhere near the cost of a flight, which averages about $10,000. Operators try to make up the difference from privately insured patients, billing some of them $40,000 or more. Insurers don't always pay the entire bill and sometimes pay nothing, leaving patients owing tens of thousands of dollars.

Pennsylvania lawmakers and the insurance commissioner said last week they want to protect patients from such shocking bills, but can't because a federal law prohibits states from regulating the industry.

"A person in this situation, and I'm sure there are many, feels rather helpless and does not know where to turn for protection from what I would consider predatory practices," Gary Karwaski of Dallas, Luzerne County, said at a news conference Monday.

Karwaski said he was billed $42,569 for a flight to a Scranton hospital two years ago after he fell from a cabin roof in the Poconos. He said his insurer paid $12,207, leaving a balance of $30,362 that his attorney later negotiated to $7,500.

"While I greatly appreciate the service that was provided, the whole affair caused me more mental anguish than the actual injury which I suffered from the fall," Karwaski said.

State Rep. Tina Pickett, R-Bradford, said a constituent got a $35,000 bill after insurance paid $20,000. The Insurance Department gets about a dozen complaints a year.

State regulation of air ambulances is blocked by the Airline Deregulation Act of 1978. Federal judges cited that law last year when overturning regulations in North Dakota and Wyoming after helicopter companies sued.

State Insurance Commissioner Teresa Miller wrote to Pennsylvania Sens. Pat Toomey and Bob Casey last week, urging them to support pending legislation to give states regulatory authority.

"These vital services save lives but must be affordable to the consumers who need them," she wrote.

Helicopter operators believe the answer is to increase Medicare and Medicaid payments.

"Without that, this problem is going to continue," Paul Webster, a vice president at Air Methods, told the state House Insurance Committee on Tuesday.

Seven of every 10 patients transported by Air Methods are uninsured or have Medicare, Medicaid or other government insurance, he testified. Medicare typically covers about half the cost of a flight, while Pennsylvania Medicaid pays only $200, the lowest rate in the nation, plus mileage.

"Simple arithmetic will tell you that if air medical transport companies are reimbursed substantially below cost for 7 out of 10 transports, then the remaining transports essentially pay for the whole system," Webster testified.

Air Methods works in 48 states and provides helicopters for Lehigh Valley Health Network. The health network provides the medical crew.

Keith Micucci, LVHN's director of emergency transport and MedEvac, told me few people complain about bills and those who do are referred to Air Methods.

He said LVHN developed an alternative to flights taking patients from one hospital to another by using critical-care vehicles to drive some patients.

PennStar, which is owned by the nonprofit University of Pennsylvania Health System, supplies helicopter services and staff for St. Luke's University Health Network. St. Luke's has not received billing complaints, spokeswoman Mary Beth Golab said.

Further complicating this issue is a sometimes tense relationship between helicopter operators and health insurers.

They often can't reach agreements for operators to participate in insurance networks. It's those situations that result in patients getting large bills because they are responsible for paying what their insurer doesn't, a practice known as "balance billing." If an operator is in-network, the patient pays only a deductible or co-pay.

Michael Yantis, vice president of state government affairs for Highmark, testified at Tuesday's Insurance Committee meeting that insurers have difficulty getting for-profit helicopter services to join networks and Highmark has none under contract.

Webster countered that some insurers deny or underpay claims. He said it's easier for hospital nonprofit operators to join insurance networks because they have other revenue sources, such as from the hospital budget. He said for-profit companies would like to join and could better negotiate if they received fairer payments from Medicare and Medicaid.

Yantis said insurers can't just pay the entire bill for out-of-network services because while that would protect some consumers, the cost would be passed to others through higher premiums.

If you receive a surprise bill, try negotiating with the helicopter operator. Webster said AirMethods works with patients and has a charity care program.

"Our intent is never to put our patients in financial hardship," he testified.

Karwaski said the company that flew him -- it wasn't Air Methods or PennStar -- told him it might be able to come to a "financial arrangement" if he submitted tax returns and financial records. He declined and his account was sent to collections, which is when he hired an attorney.

You can file a complaint with the Insurance Department (877-881-6388, www.insurance.pa.gov). Miller said the office has helped some people by getting insurers to reconsider claims.

The Watchdog is published Thursdays and Sundays. Contact me at watchdog@mcall.com, 610-841-2364 or The Morning Call, 101 N. Sixth St., Allentown, PA, 18101. I'm on Twitter @mcwatchdog and Facebook at Morning Call Watchdog.

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