By Harry Samler – CBS46 (watch now)
DAWSONVILLE, GA (CBS46) After Better Call Harry helped save a Griffin family more than $24,000 on an air ambulance bill, he received a plea from a Dawsonville family.
They owed the same air ambulance company more than $30,000 after insurance paid a portion of the bill to transport 7-year-old Luca from one hospital in Gainesville to another in Atlanta where he could get the emergency care he needed.
After flatlining, Luca was able to be revived by doctors, and his grandmother is grateful for the efforts of the air ambulance company. But representatives of the company continue calling her and asking her to advocate with her insurer to pay more of the bill.
Representatives with Air Methods released this statement to CBS46 News:
“With every single mission, we are solely focused on providing safe and necessary care to patients in emergency situations. We are grateful that Luca was able to get the care necessary last January and we were able to help him get to Scottish Rite Hospital in Atlanta so that they could provide the additional care he needed for his condition.
We are acutely aware of and sympathetic to the complex maze the current healthcare system has become that his family is now having to work through. Our Patient Advocacy team has been diligently working with and on behalf of Luca’s family since January of 2018 to resolve this issue and to work with both Anthem Blue Cross Blue Shield of Georgia as well as Amerigroup Georgia – Medicaid for Luca’s care.
While we are still working with all parties to resolve this issue, we were surprised to learn that Anthem Blue Cross Blue Shield of Georgia initially denied payment on this claim based on medical necessity in June 2018. This claim denial did not include a review by a physician or nurse, which lead us to request the claim be reviewed again. Since then, we have continued to work with Luca’s family to move the claims through the process with Anthem Blue Cross Blue Shield of Georgia and will continue to do so with their other insurance providers until we can come to a positive resolution.
As an organization, Air Methods does not self-dispatch – we only send our crews out when requested either by EMS or clinicians when they determine we are necessary. By having insurance providers deny claims based their determination of medical necessity undercuts clinicians who must make a judgement call when patients’ lives are at stake. It also leaves patients and their families confused and concerned about the state of healthcare they or their loved ones receive.
As an industry, emergency air medical providers are on call 24/7/265. Each emergency air medical provider base costs nearly $3 million per year to operate, according to an independent cost study. Further, approximately 85% percent of costs are fixed costs associated, giving these companies little leeway in reducing costs on their own.
While there is a small amount of variable costs, the inequity that is talked about is due to Medicare’s low reimbursement rates, which exert a trickle-down economic effect on air medical service rates for private payers and patients. The consequences of this imbalance are dramatic. Reimbursement for seven out of every 10 transports does not cover the cost, according to the AAMS. The result is cost-shifting onto the three out of 10 patients who are commercially insured to offset the low reimbursements for Medicare, Medicaid and uninsured patients.
This imbalance is why we continue to work with the family’s insurance to make sure we are able to receive the necessary payment so that we can continue to provide this invaluable service to bridge the healthcare gap nationwide.“
CBS46 also received this statement from officials at Anthem Blue Cross and Blue Shield:
“Anthem Blue Cross and Blue Shield strives to provide our consumers with access to quality, affordable healthcare services. Part of our efforts includes contracting with a variety of transportation services, and we are pleased we were able to recently come to agreement on a reasonable contract with Air Methods effective January 1, making its services available to our consumers at in-network rates.
However, if a provider is out of network at the time services are rendered, those providers do not have an agreed-upon price with Anthem. Therefore by choosing to remain out of our network, providers — including transportation services — can charge whatever they desire. While we do reimburse for these out of network transportation services at a higher rate than Medicare, often times transportation companies will go directly to the consumer to try and collect the remaining unpaid billed amount. Despite our best efforts, this ability to bill the consumer for the balance provides little incentive for many of these companies to contract with us at a reasonable rate.“
Better Call Harry has more on a healthcare story that’s affecting more and more people nationwide.
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Source: WGCL-TV