This story additionally ran on NPR. This story may be republished free of charge (details).
It was the primary — and solely — time Dr. Naveed Khan, a 35-year-old radiologist, ever rode in an all-terrain automobile.
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Khan took the wheel from his pal and drove circles within the sand, on a path alongside the Red River in Texas.
“As soon as I turned to the side where my body weight was, this two-seater vehicle … just tilted toward the side and toppled,” Khan recalled. It landed on his left arm.
“I had about a 6-inch-wide exposed flesh gap that I could see below, on my forearm,” he mentioned. “And I could see muscle. I could see the fat. I could see the skin. The blood was pooling around it.”
Khan, feeling lightheaded, tied his jacket round his arm like a tourniquet. He and his pal managed to proper the ATV, drive again towards the road and name 911.
When an ambulance delivered him to the emergency room at United Regional Health Care System in Wichita Falls, Khan was shocked to listen to a health care provider murmur that it was the worst arm damage he’d ever seen.
Khan wanted fast helicopter transport to a trauma heart for surgical procedure in Fort Worth, if there was any hope of saving the arm.
Groggy from painkillers, Khan managed to ask the medical doctors how a lot the flight would price and whether or not it will be lined by his insurer. “I think they told my friend, ‘He needs to stop asking questions. He needs to get on that helicopter. He doesn’t realize how serious this injury is,’” Khan recalled.
Flown 108 miles to John Peter Smith Hospital in Fort Worth, the closest Level I trauma heart, Khan was whisked into surgical procedure to wash out the wound, restore his shattered bones and get blood flowing to the tissue.
He had a complete of eight operations to attempt to save his left forearm earlier than he lastly gave up. After weeks within the hospital, he requested the medical doctors to amputate, so he might get on along with his life.
And then the invoice got here.
Patient: Naveed Khan, 35, a radiologist and married father of three young children in Southlake, Texas.
Total invoice: $56,603 for an air ambulance flight. Blue Cross Blue Shield of Texas, Khan’s insurer, paid $11,972, after initially refusing altogether; the medevac firm billed Khan for the remaining $44,631.
Service supplier: Air Evac Lifeteam, an air ambulance firm that operates 130 bases in 15 states. It’s owned by Air Medical Group Holdings, a holding firm that owns 4 different air ambulance firms and one floor ambulance firm. Air Medical, in flip, is owned by the large personal fairness agency Kohlberg Kravis Roberts, or KKR.
Medical service: Khan was flown from the United Regional Health Care System in Wichita Falls, Texas, to the John Peter Smith Hospital in Fort Worth.
What provides: Khan received his first name from Air Evac Lifeteam simply three days after the accident, whereas he was nonetheless mendacity within the hospital. An organization consultant advised him the helicopter experience would doubtless price greater than $50,000 and requested him how he deliberate to pay.
For Khan, fast transportation to the trauma heart was completely important for the reason that blood provide to his arm had been reduce off, mentioned Dr. Raj Gandhi, the medical director for trauma companies at JPS Hospital.
“If there’s no blood going that means there’s no oxygen,” he mentioned. “It there’s no oxygen, that means those cells are going to die.” Minutes are treasured and the helicopter can get from Wichita Falls to Fort Worth in an hour or much less, half the time it takes by floor ambulance, he mentioned.
But complaints about sky-high payments to sufferers for air ambulance companies are widespread. Since launching the “Bill of the Month” collection in February, NPR and Kaiser Health News have obtained greater than a dozen payments from critically sick sufferers like Khan who have been charged tens of hundreds of dollars for an air ambulance experience even after insurers’ funds.
Khan cooks lunch for his spouse, Ayesha, and kids, Nazneen, 7, Yasmeen, four, and Rehan, 1, of their house in Southlake, Texas.(Shelby Knowles for NPR)
Air ambulance firms defend their fees.
Rick Sherlock, president of the Association of Air Medical Services, a commerce group, mentioned air ambulances require a extra extremely educated crew than a floor ambulance, as a result of solely the sickest or most critically injured sufferers want air transport.
AAMS commissioned a study to find out the precise price of a medevac experience. The report discovered it takes about $2.9 million a 12 months to run a single helicopter base. Each base handles about 300 transports a 12 months, and the rides price about $11,000 every, in keeping with the report.
A spokeswoman for Air Evac Lifeteam mentioned the corporate payments folks a lot as a result of it’s attempting to make up for what she mentioned are meager funds from Medicare and Medicaid.
“Our real cost per flight is the $10,200 plus the unreimbursed cost on each flight for Medicare, Medicaid and patients without any coverage,” wrote Shelly Schneider, the corporate spokeswoman.
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The Centers for Medicare & Medicaid Services mentioned it pays a mean of $four,624 per experience, plus $31.67 a mile — which works out to a mean Medicare reimbursement of $6,556 for helicopter ambulance rides for seniors. Medicaid in most states pays much less.
The trade has been advocating exhausting to get Medicare to spice up its reimbursements, Sherlock mentioned. Legislation pending in each the House and Senate would accomplish that, however there hasn’t been a lot motion on these payments.
Others say the trade’s price estimates are inflated by profit-driven growth of a profitable trade. Ground ambulances typically carry critically sick sufferers, too.
Too many air ambulances sit idle a lot of the time, mentioned Dr. Ira Blumen, a professor of emergency medication on the University of Chicago and medical director of the college’s Aeromedical Network.
Blumen mentioned the trade — which is dominated by a number of firms owned by personal fairness corporations — expanded dramatically the final time Medicare boosted its funds, in 2002. And now there are too many helicopters — 908 as of final 12 months — preventing for sufferers and income on the similar time.
“The number of helicopters is outrageous for the continental United States,” he mentioned. In the 1990s, most helicopters ran greater than 500 flights per 12 months on common. At that charge, the price per flight at this time can be lower than $6,000.
“The biggest challenge for me was to see how I would be a father again,” mentioned Dr. Naveed Khan, who was injured whereas driving an all-terrain automobile. (Shelby Knowles for NPR)
“With two able-bodied parents at home, it was easier,” he mentioned. (Shelby Knowles for NPR)
A BCBS of Texas spokesman mentioned the insurer does have a contracted charge with an in-network air ambulance firm, however it isn’t Air Evac Lifeteam. After initially refusing to pay something for an out-of-network declare, it agreed to the $11,972 fee.
But in some sense, the rationale ambulance firms cost a lot is just because they will: Air ambulances are largely regulated not as well being care however as a part of the aviation trade. Federal legal guidelines forestall states from limiting aviation charges, routes and companies.
So many individuals have been hit with shockingly excessive air ambulance payments that members of Congress on either side of the aisle are attempting to do one thing about it. Legislation to reauthorize funding for the Federal Aviation Administration that’s shifting by way of Congress now would arrange a council of trade consultants to handle steadiness billing and different points, and arrange a grievance line for shoppers.
Resolution: Khan has allowed Air Evac Lifeteam to barter with BCBS of Texas over the remaining $44,000 air ambulance invoice. The firm has requested him to attraction to the state’s Department of Insurance, and although he first balked on the suggestion, he’s now contemplating doing so. Khan says he doesn’t perceive why the helicopter flight, an integral a part of the emergency medical care he obtained, is handled in a different way than his surgical procedures, nursing care and bodily remedy.
“I thought that this was another piece of that puzzle,” he mentioned. “It turns out that this was glaringly different.”
He is ready for decision as he will get accustomed to life along with his incapacity. Holding his child son, he requested in frustration: “How do I hold him while he’s crying and at the same time heat up his bottle?”
“It’s unfair,” Khan says. “It’s random, it’s arbitrary. It’s whatever price they want to set. And to put that onto a person who’s already been through what I’ve been through, I hate to say it, but it’s cruel.”(Shelby Knowles for NPR)
Khan, who has needed to combat along with his insurance coverage firm to get protection for a prosthetic arm, is annoyed to be taught that the air ambulance firm expects him to pay excess of the precise price of his flight.
“It’s unfair,” he mentioned. “It’s random, it’s arbitrary. It’s whatever price they want to set. And to put that onto a person who’s already been through what I’ve been through, I hate to say it, but it’s cruel.”
The Takeaway: Most folks with well being issues severe sufficient to require a helicopter flight are in no place to ask if the medevac firm is in-network or whether or not there’s a selection. But in case you or a member of the family has time to ask, it might repay.
Steps it’s best to take in case you’re confronted with an enormous invoice for a medevac experience:
First, let your insurer’s course of play out. Blue Cross Blue Shield of Texas first denied Khan’s declare altogether. But he regarded intently at his coverage and noticed that the specter of lack of limb was explicitly lined. He appealed, and that’s when the insurer paid $11,972. Second, negotiate! The air ambulance firm is perhaps prepared to barter a settlement for a fraction of the invoice to keep away from turning to debt collectors, who would pay them pennies on the greenback.
Both Sherlock of the Association of Air Medical Services and Schneider of Air Evac Lifeteam mentioned firms will attempt to decide what a affected person can afford. So folks with excessive incomes might discover it exhausting to acquire a considerable discount for his or her invoice. Still, if sufferers know the true price of the service they obtained, they could be higher geared up to barter a reduction.
Many air ambulance firms supply membership plans that may price lower than $100 a 12 months, and assure that the corporate will settle for no matter fee an insurance coverage firm makes with out billing the affected person for the remainder. But purchaser, beware: When somebody wants an air ambulance, they’re typically not ready to decide on which firm will reply to the decision.
Bill of the Month is a crowdsourced investigation by Kaiser Health News and NPR that dissects and explains medical payments. Do you’ve an attention-grabbing medical invoice you wish to share with us? Tell us about it!
This story additionally ran on NPR. This story may be republished free of charge (details).
Alison Kodjak, NPR News: @alikodjakNPR
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