X

Life-saving flights leave some St. Lawrence County residents with massive debt

Posted 8/5/17

POTSDAM – St. Lawrence County residents who receive air ambulance flights from Air Methods may face bills as high as $60,000, even if they have health insurance. Air Methods employs 4,500 people …

This item is available in full to subscribers.

Please log in to continue

Log in

Life-saving flights leave some St. Lawrence County residents with massive debt

Posted

POTSDAM – St. Lawrence County residents who receive air ambulance flights from Air Methods may face bills as high as $60,000, even if they have health insurance.

Air Methods employs 4,500 people and operates more than 400 facilities throughout the United States providing emergency medical transports to 100,000 people annually. One of those operations is based in Potsdam, where it has provided air ambulance services throughout the region since 2012.

The company charges as much as $65,000 for flights, a number of health insurance plans will not cover the costs, and Air Methods can be very aggressive when trying to collect bills, an investigation by North Country This Week has revealed.

Fear of Repercussions

While North Country This Week does not normally use anonymous sources, for the purpose of this story names are being withheld to protect those involved from financial repercussions when trying to settle bills with the company.

One person who owed more than $30,000 after insurance paid part of the bill, reached out to North Country This Week for help but later declined further comment after Air Methods allegedly agreed to negotiate a substantial settlement under the condition that a confidentiality agreement be signed. The agreement bars the person from speaking publicly about the issue.

When asked for response for this story, Air Methods farmed out communications to Sard Verbinnen & Co., a self-proclaimed “strategic communications” firm based in California.

Nazan Riahei, who answered questions on behalf of the company, steered away from discussing the company’s billing practices, but did provide some prepared statements via email.

“We are committed to giving our patients the best possible experience from beginning to end. We balance bill only as a last resort and, in these cases, work with patients one-on-one to recover what they deserve from their insurance company and determine what they can reasonably pay,” she said.

But for some people who dealt with the company, the experience was far from pleasant. In two of the three cases investigated by North Country This Week, patients began receiving phone calls from a company called Rocky Mountain Holdings weeks before receiving a bill from Air Methods. The calls were apparently synced with the insurance payments arrival to their homes.

Because Air Methods is out-of-network for all insurance providers in the North Country, checks issued to cover the cost for service are sent directly to the patient, but Air Methods knows when the checks are issued and does not waste time informing patients that the checks need to be handed over.

During the NCTW investigation, all three individuals with direct experience with Air Methods air transports had insurance coverage through Excellus Blue Cross Blue Shield, but because of differences in their plans, the shares paid by the provider greatly varied.

Not Covered

One man who works for a major St. Lawrence County employer was flown to Syracuse following an incident involving his heart. The man was unconscious when the decision was made by an emergency room doctor to transport him. His spouse signed the necessary paperwork, but that document provided no indication of how much the flight would cost.

He says he later found out that the reason he was flown out the region was due to a lack of staffing to care for him at the hospital, because the event occurred over a holiday.

Within a few weeks of returning home, he received a bill for $59,999. At first he said he was not concerned, believing that his insurance would cover it. But then he received notice that the air ambulance was not covered. He filed an appeal, but was unsuccessful.

Not long after that, Rocky Mountain Holdings turned the issue over to a collection agency. The man, who has a mortgage and kids, said he was shocked that a flight from St. Lawrence County to Syracuse could cost $60,000, a price tag he could clearly not pay.

It’s been more than a year since he first began receiving collection calls and the issue remains unresolved. He worked with Assemblywoman Addie Jenne, D-Theresa, and Sen. Patty Ritchie R-Heuvelton, as well as a variety of other government officials and agencies for help, but the bill remains open, active and unpaid.

He also worked with his employer, a local healthcare provider, but they offered no help.

He said the representatives were successful in getting the bill out of collections, but he still owes Air Methods $60,000, which he says is about the same amount he owes on his home.

The experience is crushing. He said it has put massive strain on his family. He continues to work with Air Methods for resolution. However, before the company would even consider reducing the amount he owed, he had to disclose an uncomfortable amount of personal information.

The four-page-document, which was provided to North Country This Week, seeks tax returns, estimated costs for groceries, auto loans, mortgage statements, pay stubs, cellphone bills, utility bills, bank account numbers and even social security numbers.

He says filing the document was nerve wracking. He felt as if sending it in could let the company take everything from him, but after a year of exploring options, he had no other options. When he finally filed the report, the company informed him he would need to submit a second application including similar information for his wife.

To date, Air Methods has not offered to reduce his $60,000 bill.

Partially Covered

Another man who suffered a heart-related issue received two flights, with bills totaling more than $130,000.

He said the first flight may have been warranted, but even at the time he was skeptical. However, following the doctor’s recommendation, he took the flight to Syracuse where he received treatment and was released.

Less than a month later, he began to feel strange and returned to the hospital for treatment. He said the doctor again urged him to take an air ambulance to Syracuse. The patient, questioned if ground transport might be a better option, but in the end he was again flown to Syracuse and was released not long after. In this instance, he said he did not suffer a heart-related issue.

After he returned home, he began receiving phone calls from Rocky Mountain Holdings, before he even received a bill from Air Methods. At first, he wrote the calls off as interested parties seeking real estate, but then realized Rocky Mountain Holdings was the parent company of Air Methods.

His insurance covered a large portion of the bill, but still left him with a balance of more than $30,000. Having received the checks from his insurance company, he had hoped to come to an agreement with the company before handing them over. The checks totaled more than $90,000, which he felt was adequate reimbursement for the flight, but he says the company refused to negotiate until they received the partial payment.

He then appealed to his insurance company to see if they would cover the balance, but the appeal was denied.

At more than 70 years old, the man feared that the cost of the flight may be passed on to family members, should he pass away. He reached out to state officials, the hospital and his insurance company, as well as an attorney but said none could provide him with the assistance he needed.

However, after a conversation with the press, he said he was contacted by the company and asked to fill out the same financial disclosure described above. In addition to that disclosure, he says he was asked to fill out a confidentiality agreement that would restrict him from discussing interactions with company in exchange for reduction in his balance.

Fully Covered

Another person who shared a bill from Air Methods with North Country This Week described a much smoother transaction. The person is the spouse of a patient who received medical transport. In this case, the insurance plan covered the full $65,000.

However, the company again began requesting payment prior to issuing a bill to the patient. This person was surprised to find a $65,000 check in the mail from the insurance company, just before receiving a request for payment from Rocky Mountain Holdings even before a bill was received.

Once the bill arrived, the payment was made and that ended the interactions.

Bigger Problem

While the cost of air ambulance service is likely astronomical when considering the 24/7 staffing it provides, reports from news organizations ranging from the New York Times to ABC News have shown the amount passengers are charged vastly exceeds the costs.

Indeed, the people who spoke to North Country This Week were shocked that a short flight could cost more $60,000, and they are not alone.

A class action lawsuit filed against the company alleges the company charges “higher prices that bear no reasonable relationship to the services rendered or what is customarily charged for the service,” according to a 2016 article from the Lexis Legal News, which references the complaint.

A story by ABC News published in 2015 also shares testimonials much like those heard by North Country This Week, giving further credence that the problems are wide spread.

Assemblywoman Jenne, says she and her staff are approached by a few people each year who are being badgered by Rocky Mountains Holdings and says she is working on legislation to address the issue.

“We have worked to help people mediate the outrageous bills as best we can,” she said.

Jenne says that her office has some success in helping negotiate lower bills, but the problem really needs to be tackled at the federal level. Unlike ground ambulance service, air ambulance services are regulated at the federal level, she said.

She says the state legislature has the authority to regulate the ground ambulance industry, but can’t set any limits on the air ambulances.

“We really need a champion to do something about this at the federal level, to hold them accountable,” she said. “Or we need the federal government to give us the ability to do something about it.”

However, Jenne says that action would not be in the best interest of the air ambulance companies, which are powerful lobbyists.

Jenne, who is a proponent of universal healthcare, said a single-payer system would also solve the problem.

Why So High?

According to Nazan Riahei, the spokesperson with the communications firm hired by Air Methods, the average cost of being ready to deploy an airborne intensive care unit is $3 million per base per year, which includes the flight nurses, flight medics, EMS pilots, mechanics, crew quarters, fuel and the multi-million dollar aircraft. Actual costs for different base locations does vary from that $3 million average cost.

But she says the fundamental problem facing the industry is that the majority of patients have either Medicare, Medicaid, or some other government insurance. Current reimbursement rates by Medicare, Medicaid and some private insurance falls “woefully” short of what it actually costs to carry air medical transports, Riahei says.

“To continue to provide access to our lifesaving services for the people and communities that need it the most, we must start by fixing the drastically low reimbursements from Medicare and Medicaid services. We strongly support the proposed federal legislation that would resolve the Medicare reimbursement shortfall by updating reimbursement rates. As a responsible provider, we are working toward long-term and meaningful solutions and we continue to try to build collaborative partnerships with insurers who share our goal of putting the patient first and recognize the value of our lifesaving services,” she said in a prepared emailed statement.