AUDIE CORNISH, HOST:
I'm Audie Cornish.
MARY LOUISE KELLY, HOST:
And I'm Mary Louise Kelly with the latest installment in our Medical Bill of the Month series. NPR, along with Kaiser Health News, has received nearly a thousand of your bills. They're often complicated. They are often expensive. A dozen listeners sent in bills for their air ambulance rides. Now, these stories are remarkably similar. A helicopter company charges tens of thousands of dollars for a ride; insurance pays only a fraction; the patient gets billed for the rest. NPR's Alison Kodjak brings us one of those stories. And a warning - there are graphic descriptions of a wound.
ALISON KODJAK, BYLINE: Dr. Naveed Khan is a radiologist in the Dallas suburbs, and his life has changed in a lot of ways since he lost his left arm in December, like how he cares for his 1-year-old son.
NAVEED KHAN: How do I hold him while he's crying and at the same time heat up his bottle?
KODJAK: He now depends on his wife to help him dress.
KHAN: She helps me put on things in the morning when I get going. I mean, she's there at night when I need her.
KODJAK: And there's at least one thing that he doesn't miss.
KHAN: I haven't changed a poopy diaper since I got home from the hospital (laughter). That used to be my job - all the poopy diapers.
KODJAK: Khan and his wife, Ayesha, have three preschool-age kids. They live a typically busy life of two professionals with young children.
UNIDENTIFIED PERSON #1: Come on, hurry, eat it (foreign language spoken).
UNIDENTIFIED CHILD #1: But I'm not hungry right now.
KODJAK: When I visit them in their suburban Dallas home, they've just picked up the kids from day care and are feeding them takeout.
UNIDENTIFIED PERSON #2: You want more? Yeah. No, oh, don't spit.
UNIDENTIFIED CHILD #2: (Laughter).
KODJAK: We sit down and talk about his accident. He had gone to Wichita Falls with a friend to ride ATVs. It's about two hours from Dallas near the Oklahoma border. They went riding along the banks of the Red River. And then his friend told him to take the wheel.
KHAN: And he said, all right, you get in the driver's seat because at that point he had mostly been doing the driving.
KODJAK: Khan did a few circles in the sand and then turned back, and the ATV tipped over.
KHAN: In a second, I was on my side, realized that I couldn't move my arm much.
KODJAK: He worked his way out of his seatbelt and took off his jacket.
KHAN: And when I looked down on my arm, I had about a 6-inch-wide exposed flesh gap that I could see below on my forearm. And I could see muscle. I could see the fat. I could see the skin, and blood was pooling around it.
KODJAK: Khan and his friend are both doctors, and they could see that this was serious, but they were pretty far from the road. So they made a tourniquet from his jacket. Then they struggled to get the ATV upright and on the trail again.
KHAN: I slumped into the side, and he just let it rip. And then we just went as fast as we could. He was just gunning it.
KODJAK: When they reached the road, he got into an ambulance.
(SOUNDBITE OF AMBULANCE SIREN)
KODJAK: The ambulance brought Khan here to the emergency department at the United Regional Health Care System in Wichita Falls. They told him that they couldn't treat him here, and he would need to go to the trauma center in Fort Worth by helicopter.
KHAN: They took one look at it and said that is one of the worst forearm injuries we've ever seen.
KODJAK: Khan, by now groggy from painkillers, asked the doctor how much it would cost.
KHAN: And he said, I have no idea. And I think they told either my friend or someone that, look; he needs to stop asking questions. He needs to get on that helicopter. He doesn't realize how serious this injury is.
KODJAK: The helicopter brought him to the John Peter Smith Hospital in Fort Worth. Rajesh Gandhi, the head of trauma surgery there, shows me where Khan landed.
RAJESH GANDHI: This is our helicopter pad.
KODJAK: Gandhi says in Khan's case, speed was important because the blood flow to his arm was compromised.
GANDHI: If there's no blood going, that means there's no oxygen. There's no oxygen, that means those cells are going to die.
KODJAK: Khan spent three weeks at JPS hospital. He had eight surgeries to try to save his arm. But in the end, they weren't successful. His arm was amputated in December. Still, his doctor says time was crucial to any hope of saving it, and the helicopter added to that hope, but it came with a price. The helicopter company, Air Evac Lifeteam, called Khan just three days after the flight while he was still lying in his hospital bed.
KHAN: They said it was going to cost over $50,000, and said, yeah, how do you want to pay for it?
KODJAK: The bill was $56,000. Khan's insurance paid $12,000, so he still owes $44,000. So how did Air Evac Lifeteam come up with that price? The company wouldn't do a recorded interview, so I asked Rick Sherlock. He's the executive director of the Association of Air Medical Services. He says the average cost for an air ambulance ride is $10,200.
RICK SHERLOCK: But that number needs to be placed in context. You know, it costs roughly $3 million a year to run an air medical base.
KODJAK: He says Medicare, which accounts for about half the air ambulance rides, pays only about $6,500, and Medicaid pays even less.
SHERLOCK: You have to solve the problem of the vast under-reimbursement.
KODJAK: So Air Evac Lifeteam and other medevac companies try to get people like Khan who have insurance and maybe a good income to pay the difference. But Dr. Ira Blumen says those helicopter rides don't need to cost that much.
IRA BLUMEN: I think overall we have too many helicopters serving the continental United States.
KODJAK: Blumen is an ER doctor and runs the air ambulance program at the University of Chicago, and he tracks the industry more closely than just about anyone. He says the number of air ambulances grew dramatically in the early 2000s when private equity companies started buying them up and expanding.
BLUMEN: It's true that what Medicare reimburses is below that range of $10,000 to $12,000 that it would cost per flight. But if they were doing more flights because there were fewer aircraft, then there would be a better ratio for the reimbursement.
KODJAK: He says that in the 1990s, helicopters generally flew more than 500 patients a year. At that rate, each ride today would cost less than $6,000. When I explain all this to Naveed Khan, he's angry.
KHAN: It's random. It's arbitrary. It's whatever price they want to set. And to put that on a person who's already been through what I've been through, it's - I hate to say it, but it's cruel.
KODJAK: Alison Kodjak, NPR News.
KELLY: And if you have a medical bill you want to share with us and with our partners at Kaiser Health News, you can do that. You can do it online at NPR's Shots blog.
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