Air ambulance rides come with high cost

[x635 4,066]

Air ambulance rides come with high cost

Consumers should check what insurance pays

Published : Thursday, 11 Nov 2010, 6:00 PM CST

Nanci Wilson

AUSTIN (KXAN) - If you are in an accident, will your health insurance cover the costs? What if you have to be air-flighted to the hospital?

More and more consumers are finding themselves stuck with huge bills after being transported in a medical helicopter.

http://www.kxan.com/dpp/news/investigations/air-ambulance-rides-come-with-high-cost

[Ga-Lin 86]

http://www.kxan.com/dpp/news/investigations/air-ambulance-rides-come-with-high-cost

A very informative & interesting article, a must read for all of us. We tend to overlook the fact that, in the medical field, we're pretty unique. On the basis of our sole judgment (and unfortunately & frequently without oversite or review after the fact) we are able to mobilize a vast amt. of resources (med evacs,HAZMAT, additional manpower etc.) & spend thousands of $ on just a phone or radio call. No one else in the medical field, except for MD's can say that. Granted its not our money but someone has to pick up the tab. From what I gathered in reading the art. the responders were treating "what might" instead of "what is". Kind of reminds me of that recent post "Mechanism of injury" on you-tube. (very funny). It also appears that they didn't follow est. policy regarding Med evac guidelines. This also reminds me of another recent post about responding L&S where some stated they disregard est. policy based on their "knowledge" of location, pt etc. or just their "judgment" to disregard dispatch instructions or agency policy. Very dangerous, you could very easily find yourself standing alone holding the bag.

Edited November 19, 2010 by Ga-Lin

[xfirefighter484x 234]

Very poignant article. Something that most responders do not even bat an eye at, or take into consideration.

Can't even tell you how many people that came in via medivac when I worked in the ER, that were discharged the same day.

[StOpGoBlUE 11]

Well as for someone who can say.. i was in a ATV accident about 3 years ago in Putnam valley , i was flown from Putnam valley to WMC and the cost of that ride was not covered by my health insurance or my ATV insurance the cost was pretty hefty i wanna say at that time it was about $14,375.. but i was given the utmost best care i have ever received in my life and i thank god for that... now a days i just don't know if anybody could afford to be flown even if they are in seriously injured.. i only walked away with a few scratches and torn muscle in my back i was discharged about 4 hours later .. i can say i do believe i could have been taken by ambulance but due to the MOI. i believe it gets overlooked because all i can remember was hearing the medic as he approached before he even made patient contact was fly the helicopter.. unless you really need a medivac i do not believe they should be used

[INIT915 1,119]

Well as for someone who can say.. i was in a ATV accident about 3 years ago in Putnam valley , i was flown from Putnam valley to WMC and the cost of that ride was not covered by my health insurance or my ATV insurance the cost was pretty hefty i wanna say at that time it was about $14,375.. but i was given the utmost best care i have ever received in my life and i thank god for that... now a days i just don't know if anybody could afford to be flown even if they are in seriously injured.. i only walked away with a few scratches and torn muscle in my back i was discharged about 4 hours later .. i can say i do believe i could have been taken by ambulance but due to the MOI. i believe it gets overlooked because all i can remember was hearing the medic as he approached before he even made patient contact was fly the helicopter.. unless you really need a medivac i do not believe they should be used

And with that one statement, you summed up many of the problems and complaints with air medicine.

[StOpGoBlUE 11]

I agree very strongly with that statement, the accident happened at 4pm. By the time they reached me it was 4:20 and they called the helicopter. By the time they got me out and to the road we still had to wait about 10-15 mins for the helicopter to arrive. They had to shut down the Taconic cause that's were they landed the helicopter. I was BLS critera acording to NYS protocols. STAT-flight charges at that time i believe $195 per mile and it was $8000 alone in fuel. <BR><BR>I hope this story opens up EMS providers eyes about being so quick to call for medivac during hard times and not because they dont wanna drive an extra 10-15 mins to the trauma center ER.

[JM15 386]

Can a conscious patient refuse medevac? Would you just document it on the PCR?

[helicopper 1,050]

Can a conscious patient refuse medevac? Would you just document it on the PCR?

Absolutely. The same way they can refuse treatments, transport or anything. Providing of course that they're conscious and alert.

[Ga-Lin 86]

Can a conscious patient refuse medevac? Would you just document it on the PCR?

They can, just as they can refuse going to the hosp, C-Spine, IV etc as long as they are able to understand all of the possible consequences IE an informed decision. If you look at the back of the PCR,refusal is for Treatment or transport. It's not that simple however. Most civilians don't understand the process. Most think it's just part of the service, (until they get the bill) just like calling FD to put out the barbecue fire that gets out of hand. Now take out west in most of the wilderness parks. They require you to sign a waiver agreeing to pay for any & ALL costs associated with any rescue &/or recovery operation which might be needed. And those costs are not the small change we're talking about here.

[xfirefighter484x 234]

I have met my fair share of people who request medivacs before any first responders AT ALL are on scene. That includes before PD, FD, or EMS are on scene.

I know in the fire service, there can be the though "I'd rather have equipment on the road I can cancel if need be, than to be behind the 8-ball once I get on scene". Of course, there is a huge difference between having a medivac in the air, on the way, than an engine company, or ladder company.

[Guest EMTPiper]

The only question or disproof I have of the article is its assumptions of the dangers of air medivac. Yes of course there is a danger factor in helicopter emergency transport; however, the comparison is flawed. How many thousands of Ambulance Crashes do we have a year? a Day? If we look at the accident to call ration, I'm not so certain that the helicopter ride is more dangerous. Realizing this was only a small point in the article, I do think the main point about cost and poor clasification of status was made. It can always be difficult to make decissions about transit when we have obstacles and horrid MOI's. Things are rarely black and white, especially in emergency medicine.

[x635 4,066]

Universal health care, and better interfacing of EMS personel with aviation transport providers.

How is someone who is in such critical condition that they need to be flown by helicopter, going to be able to verbalize or judge whether they need the helicopter? What happens if, scenario down here, you are two hours by ground with a signifcant trauma and the helicopter makes the best sense, but the patient can't afford it?

If EMS transport is only going to be for the wealthy, and not available to the poor and vunerable, then there's something seriously wrong. Also, if we're going to put a price tag on emergency healthcare, there's a potential people are going to pause to think before calling 911.

Somebody has to pay, and that should be the health insurer. EMS should have to follow certain criteria, and interfacility as well. If the criteria is not followed and documented, then the EMS Agency or Hospital should have to pay. If the patient does need a helicopter, then the insurance company should pay. And the judgement aspect should be looked at via the facts found at the scene, rather then after the fact.

Also, not all air transport medical providers are the same, or have the same motive.

[helicopper 1,050]

The only question or disproof I have of the article is its assumptions of the dangers of air medivac. Yes of course there is a danger factor in helicopter emergency transport; however, the comparison is flawed. How many thousands of Ambulance Crashes do we have a year? a Day? If we look at the accident to call ration, I'm not so certain that the helicopter ride is more dangerous. Realizing this was only a small point in the article, I do think the main point about cost and poor clasification of status was made. It can always be difficult to make decissions about transit when we have obstacles and horrid MOI's. Things are rarely black and white, especially in emergency medicine.

The accident rate is entirely too high and there are countless studies and report to substantiate that (one such report is linked below). I'm not sure what comparing with ambulance accidents will do for us but suffice it to say the EMS helicopter industry is under an increasingly powerful accountability microscope and federal regulations for them are in the offing. Here's one nugget from one report to Congress:

the study's preliminary estimates for 2008 indicate that the fatal accident rate tripled over the 2007 rate, increasing from 0.54 fatal accidents per 100,000 flight hours in 2007 to 1.8 fatal accidents per 100,000 flight hours in 2008.

Mechanism of injury is only one criteria to make a transport determination. The PATIENT is more important and their physical condition should be the compelling factor in determining if flight is warranted.

Apathy and complacency is not going to address the problem and even the NTSB and FAA are being criticized for moving to slowly to fix things. To deny the problem exists only compounds it. There are some common sense strategies that could help reduce these accidents and increase safety.

Most of the recent accidents follow trends that investigators spotted in their 2006 study of the industry's problems. Crashes tend to occur at night, in poor visibility or in bad weather, Guzzetti said. The NTSB's recommendations had the potential to cut more than half of the 55 accidents studied in 2006.

http://www.gao.gov/n...ems/d09627t.pdf

http://www.faa.gov/news/fact_sheets/news_story.cfm?newsId=11957

http://www.ihst.org/Default.aspx?tabid=1507&language=en-US

http://www.usatoday.com/news/nation/2008-10-28-ntsb_N.htm

[Bnechis 3,961]

If EMS transport is only going to be for the wealthy, and not available to the poor and vunerable, then there's something seriously wrong. Also, if we're going to put a price tag on emergency healthcare, there's a potential people are going to pause to think before calling 911.

Funny I thought it was the other way around. People with money drive themselves or call a cab unless they really need an ambulance while those looking for a free ride call 911

[efdcapt115 1,511]

Question for Chris; Are Air Ambulance Pilots ever trained and equipped with night-vision equipment? If not, is it suggested anywhere, by anybody that maybe they should be? Also, where do these companies traditionally get their pilots from? It would seem to me to be a logical extension to try and recruit former military chopper pilots, already trained in night-vision flying and med-evac, especially since the statistics you sited show a pattern regarding poor visibility accidents.

[Bnechis 3,961]

Question for Chris; Are Air Ambulance Pilots ever trained and equipped with night-vision equipment?

According to the commercial: "Denvers air Ambulance only uses Duracell Batteries in their night vision"

Some day Duracell will have a logo I could use instead....

[efdcapt115 1,511]

Ahhhh...you got me. Like you said, "be careful of the packages you open".....lol

[helicopper 1,050]

Question for Chris; Are Air Ambulance Pilots ever trained and equipped with night-vision equipment? If not, is it suggested anywhere, by anybody that maybe they should be? Also, where do these companies traditionally get their pilots from? It would seem to me to be a logical extension to try and recruit former military chopper pilots, already trained in night-vision flying and med-evac, especially since the statistics you sited show a pattern regarding poor visibility accidents.

More and more air ambulance operators are adding night vision goggles to their operations and it will likely become a requirement in the future (it may be in the draft requirements now). For years it wasn't a requirement (it wasn't even legal for a long time) and many commercial operators balked at the expense. It is about 12K per pair of NVG's and the aircraft modifications can be quite costly.

Most medevac pilots are ex-military or law enforcement. Some come from other commercial flight operations (logging, off-shore, etc.) and the minimum entry requirement is in the neighborhood of 2500 hours experience so they're not new.

[efdcapt115 1,511]

More and more air ambulance operators are adding night vision goggles to their operations and it will likely become a requirement in the future (it may be in the draft requirements now). For years it wasn't a requirement (it wasn't even legal for a long time) and many commercial operators balked at the expense. It is about 12K per pair of NVG's and the aircraft modifications can be quite costly.

Most medevac pilots are ex-military or law enforcement. Some come from other commercial flight operations (logging, off-shore, etc.) and the minimum entry requirement is in the neighborhood of 2500 hours experience so they're not new.

I SEE...(get it Barry?). Thank you Chris!

[Bnechis 3,961]

I SEE...(get it Barry?). Thank you Chris!

Thanks

I SEE

[ny10570 745]

The only question or disproof I have of the article is its assumptions of the dangers of air medivac. Yes of course there is a danger factor in helicopter emergency transport; however, the comparison is flawed. How many thousands of Ambulance Crashes do we have a year? a Day? If we look at the accident to call ration, I'm not so certain that the helicopter ride is more dangerous. Realizing this was only a small point in the article, I do think the main point about cost and poor clasification of status was made. It can always be difficult to make decissions about transit when we have obstacles and horrid MOI's. Things are rarely black and white, especially in emergency medicine.

Yes there are many more ambulance crashes, but how many are fatal?

Cost and risk are both factors we should be taking into account with patient care decisions. You're not going to deny a pt a needed resource because of cost, but you may make sure that its a needed resource.

[RWC130 594]

How many EMS providers feel that the use of the

Medevac Chopper is abused here in our area?

[64FFMJK 21]

How many EMS providers feel that the use of the

Medevac Chopper is abused here in our area?

what do you expect when agencies have tshirts that say "when in doubt fly em out"

Its not our money, really its all our money eventually since you end up paying higher fees since only 1/2 pay then they charge twice as much.

[SRS131EMTFF 471]

How many EMS providers feel that the use of the

Medevac Chopper is abused here in our area?

From my prospective we in the Northwestern suburbs have gotten a lot better at utilizing the bird when it is actually needed. Maybe the quality of the EMTs has gotten better or the knowledge that the bird is not 10 minutes away has sunk in but calls that years ago might have gotten a STAT flight response are now being transported by ground. I can not remember the last time I saw or heard of the bird being used in northwest Westchester.

[JohnnyOV 2]

From my prospective we in the Northwestern suburbs have gotten a lot better at utilizing the bird when it is actually needed. Maybe the quality of the EMTs has gotten better or the knowledge that the bird is not 10 minutes away has sunk in but calls that years ago might have gotten a STAT flight response are now being transported by ground. I can not remember the last time I saw or heard of the bird being used in northwest Westchester.

I'm willing to put a lot of money down that the only reason there are less times when the bird is being called, is due to Stat flight/Life Net moving out of the WCMC arena, and the closest base now being out of the Catskill Regional Medical Center located in Harris, NY. Lets be serious, calling the bird for an ambulance crew, is like calling the 10-75 for an arriving fire department, it's their "big one." It would make me sick when the ambulance corps of my town, would call for a helicopter for a single person pin, southbound on the Taconic and once the PT was extricated, wait in an ambulance for the helicopter to finally land 10 minutes later, when it was a 15 minute trip down the TSP to get to the trauma center. Something screams "neglect" to me when this occurs.

[SRS131EMTFF 471]

I'm willing to put a lot of money down that the only reason there are less times when the bird is being called, is due to Stat flight/Life Net moving out of the WCMC arena, and the closest base now being out of the Catskill Regional Medical Center located in Harris, NY. Lets be serious, calling the bird for an ambulance crew, is like calling the 10-75 for an arriving fire department, it's their "big one." It would make me sick when the ambulance corps of my town, would call for a helicopter for a single person pin, southbound on the Taconic and once the PT was extricated, wait in an ambulance for the helicopter to finally land 10 minutes later, when it was a 15 minute trip down the TSP to get to the trauma center. Something screams "neglect" to me when this occurs.

With neglect being defined as:

"Neglect is defined as a condition of deprivation in which a participant's health and welfare is jeopardized because of inconsistent or inappropriate services, treatment or care which does not meet their needs, or failure to provide an appropriate and/or safe environment. Failure to provide appropriate services, treatment or medical care through gross error in judgment and inattention is considered to be a form of neglect. For example, neglect occurs if a Service Coordinator is aware that an agency listed in a Service Plan cannot provide the requested services, but does not seek an alternate waiver service provider to meet the participant's needs."

http://www.nyhealth.gov/facilities/long_term_care/waiver/nhtd_manual/section_10/sri.htm

Explain to us exactly how waiting for a aeromedical transport legally constitutes neglect.

[ny10570 745]

Waiting 15 minutes for one form of transport while another form of transport could have done the job within those 15 minutes is pretty close to neglect.

[JohnnyOV 2]

With neglect being defined as:

"Neglect is defined as a condition of deprivation in which a participant's health and welfare is jeopardized because of inconsistent or inappropriate services, treatment or care which does not meet their needs, or failure to provide an appropriate and/or safe environment. Failure to provide appropriate services, treatment or medical care through gross error in judgment and inattention is considered to be a form of neglect. For example, neglect occurs if a Service Coordinator is aware that an agency listed in a Service Plan cannot provide the requested services, but does not seek an alternate waiver service provider to meet the participant's needs."

http://www.nyhealth....tion_10/sri.htm

Explain to us exactly how waiting for a aeromedical transport legally constitutes neglect.

I just had a huge response written out, then hit the back button and erased everything, so this will be the condensed version.....

inappropriate services, treatment or care which does not meet their needs - this right there, sums up my entire point. When you look at a time line of getting a patient to definitive care, why would you want to delay your patient from getting to that care? The time it takes in Westchester now, to get a bird on location (on time with their ETA), load them up and get enroute, you could have been on the road 10-15 minutes before hand and almost arriving at the hospital. Any medic or crew chief who is worth their salt, will get a pt in the bus, roll the bus immediately, and not d!ck around on scene waiting for an air ambulance, and while enroute, provide them a good level of care prior to their arrival at the hospital.

Look, I have LONG been a proponent of NO air ambulances in about 80-85% Westchester. When you're dealing with an MCI or other large scale incident, I see no problem utilizing them, instead of draining the ground system. When you can get to the hospital, just as quickly, if not quicker on the ground, why charge the pt tens of thousands of dollars because a medic wants to get his jollies off with a stat flight job.

Simple math tells you with a dispatch to in ground ambulance time of say 25 minutes with a pin job, and a 15 minute drive to the hospital, 40 minutes is well within the golden hour. Now look at it with calling a bird. Give it 10 minutes to arrive on scene, another 2 to determine you want the bird, and you get an ETA of 25 minutes for arrival. Now you're already 12 mintues behind the transport clock. Extricate the Pt in the same amount of time, and load him into the ambulance to wait for the bird. Bird arrives (actually ON TIME!!!!! Kudos!) at the 37 minute mark, add 3 minutes to load the Pt up, you're now at 40 minutes. Give him a 10 minute flight time and now you're at 50 minutes. Good job, you've cost the patient tens of thousands in medical bills, and delayed them by 10 minutes (and lets remember we ourselves are HUGE proponents of SECONDS COUNT!!!!!!!) to getting their ruptured innards repaired because you thought a air ambulance ride was in their best interest. You pull the latter of the two scenarios on me if I was in an accident, and I don't care what the outcome is, you're getting sued by me to have your license revoked.

Inappropriate services would be an air ambulance ride in 80% of the areas of this county. Period.

[SRS131EMTFF 471]

I completely understand what you are saying. Its not that I dont agree its a problem, I just I dont believe its negligence.

Luckily our firehouse lawyers are actually lawyers, including several specializing in medical malpractice, so I will get opinions from them and report back.

[helicopper 1,050]

Waiting 15 minutes for one form of transport while another form of transport could have done the job within those 15 minutes is pretty close to neglect.

Add to that the NYS BLS protocol which states that if the patient is a high priority, immediately transport. Intercept with ALS enroute. Given that most calls are covered now by ALS, there is no reason to delay ground transport in favor of air transport. That could be an argument for neglect.

The protocol also states in several different places not to delay transport so that could be an argument for neglect.