David J. Phillip/AP
Life Flight helicopters sit at the ready on the roof of Memorial Hermann Hospital in Houston.
Life Flight helicopters sit at the ready on the roof of Memorial Hermann Hospital in Houston. David J. Phillip/AP
Nobody plans on having a medical emergency so dire it requires getting airlifted to a hospital by helicopter or plane, yet it happens to more than 500,000 people every year.
Even worse, health insurance may cover only a small portion — or none — of the bill, which can easily reach tens of thousands of dollars. "I don't know of any companies that are in-network," says Erin Moaratty, chief of external communications for the Patient Advocate Foundation, referring to air ambulance companies that contract with insurers to provide services at agreed-upon rates.
The PAF provides free assistance in appealing insurance claims denials and other claims problems, including air ambulance claims.
Air ambulances typically respond to a couple of types of emergencies. During about one-third of their missions, they're sent to the scene of an accident or other emergency when medical workers judge that the injured person needs to get to a distant hospital that can handle trauma cases, for example.
More frequently, about half the time, they're used for hospital-to-hospital transport, often to fly a critically ill patient from one facility to another for specialty care. They may also be used for other time-sensitive tasks, like transporting organs for transplant.
The key to getting insurance to cover an air ambulance transport is proving to the insurer that it was medically necessary, says Tanya Walker, a clinical case manager with PAF. For example, a hospital may say that the patient was too acutely ill to be treated there, and so was airlifted to another facility to be stabilized and put on a ventilator.
But medical necessity doesn't mean the full cost of the trip will be covered, only that it won't be rejected out of hand, says Walker. Since the air ambulance is likely to be an out-of-network provider, "There is still likely to be a difference between the [insurer's] allowable charges and what is actually charged," she says, "and somebody at some point is going to bear the rest of the charge, either the provider or the patient."
But patients and advocacy organizations have some leverage. Air ambulance companies may be willing to negotiate the amount charged, or offer discounts of as much as 30 percent for prompt payment, says Walker.
Some ambulance companies also have charity care programs for people with limited means, she says. And if all else fails, at a minimum PAF caseworkers will help arrange a payment plan, so the charge won't ruin your credit.