NEWPORT, Tenn.—Five years ago, a Cocke County man filed bankruptcy after a tree fell on him, he suffered injuries and was handed a medical bill for $350,000. Although significant enough on its own to stun anyone, a large portion of the sum came as a surprise fare, owed to an ambulatory helicopter ride to the hospital, costing $50,000 by itself.
However tragic, his story is hardly unique, and follows an American trend: nearly two thirds of all bankruptcies in the U.S. take place in response to medical expenses, adding up to about 530,000 medical bankruptcies each year.
The former Conagra worker, a man in his thirties who asked not to be named for personal reasons, said he was cutting down a large tree at the edge of his property, when it suddenly collapsed, knocking him unconscious and trapping him underneath in an instant.
In many cases a person may be coherent enough to decline an ambulance and even get themselves to a hospital. In severe cases like his, however, sometimes immediate air transport to the nearest trauma center is the only recourse. It becomes a choice of life or death, and it was not his choice to make.
“When I woke up, this arm was over here, like behind me, over there, and I was pinned,” he said. “The tree was on top of me. I could not move. I hollered for 30 minutes.”
He said after he was found by a neighbor, it took another 45 minutes for paramedics to arrive. They told him he would not have made it much longer.
“I was about to go into shock, and they cut the tree off of me,” he said. “They used my saw to cut the tree off of me. The tree was as big as a tractor tire. It was humongous. They didn’t know how I survived. Somebody was watching out for me. I like to think, Mom.”
He was transported from the scene by helicopter, to Johnson City, where he stayed and received treatment for severe injuries.
Following that traumatic event, Conagra has since closed their plant. He said he lost his insurance, and now has to pay several hundreds of dollars out of pocket, into the thousands, for routine hospital visits and follow-ups. Bankruptcy, he said, clears in seven years, but it still hurt his credit and does nothing to alleviate the high costs of presently needed treatments or preventive care.
For a person faced with life-threatening injury, the hospital stay – even with insurance – can be expensive. However, many do not consider the extravagant cost of air ambulatory services, which can come in the form of its own separate bill – and a surprise – especially to those who have never been transported to a trauma center before.
In the last five years, air ambulance costs have increased by more than 30%, according to data published in a September report by FAIR Health, a nonprofit organization that analyzes healthcare costs, market rates and insurance information. The study addresses both fixed-wing and rotary-wing air ambulance transport costs.
Their four-year study showed that the top diagnoses associated with helicopter ambulance rides in that period include cerebrovascular issues and diseases, heart attack, body injury, head injury and stroke.
The study showed that in a three-year period, the charges associated with helicopter ambulance transports for those events – like those used to service eastern Tennessee – increased by more than 22.2% to an average of more than $30,000 per flight.
Rates have increased so fast that the Biden Administration proposed new rules on September 10 requiring greater transparency in air ambulance costs, and how agents and brokers are compensated.
The proposal, announced through the U.S. Department of Health & Human Services, states that new rules would allow HHS to collect data to analyze market trends to address exorbitant air ambulance expenses.
“No one should avoid seeking health care for fear of receiving a surprise medical bill,” the statement read, quoting Chiquita Brooks-LaSure, Administrator of the Centers for Medicare and Medicaid Services. “The new consumer protections released today are critical to shielding consumers from the devastating financial impacts that may occur as a result of an unlawful surprise bill, and CMS is committed to vigorous enforcement of these protections.”
Because insurance may not cover the total cost of emergency treatment, and out-of-pocket costs like deductibles or copay still apply, the providers of these services usually offer annual subscription services, a product resembling insurance, against the high cost of their ambulatory services.
Depending on which hospital a patient is delivered to, the air ambulance helicopters are branded differently, but in eastern Tennessee, both are covered by a single provider, and they offer annual membership plans that cover the full expense of the flight.
In Cocke County and the surrounding areas, that service is called AirMedCare Network, and they charge $85 per year per household, or $65 for seniors age 60 and above, and their households. The program covers the full cost of the flight, regardless of insurance status.
Med-Trans, a participating provider in the program, covers flights from Newport Medical Center and areas around Cocke County either to Knoxville or Johnson City. If a patient needs to go to the trauma center in Knoxville, UT LIFESTAR brings them by helicopter. Someone destined for the trauma center in Johnson City would be transported by HEART, which replaced Wings Air Rescue last year.
A dispatcher for First Call Ambulance Service confirmed that all their requests for an air ambulance go through AirMedCare.
“We do have more than one helicopter service,” Chad, the dispatcher said, “but they’re all owned by the same people.”
Air transport is often covered through insurance, with a copay. Humana is a for-profit American health insurance company based in Louisville, Kentucky. Because Humana is contracted with the federal government to provide and administer Medicare plans under the Medicare program, many people in Cocke County, and across the U.S., access their Medicare benefits through Humana.
Based on accounts in their system, a Humana representative working in El Paso, Texas said Humana members are charged a $250 copay for a helicopter flight, same as a ground ambulance, with an additional $250 copay required separately for any medical services performed onboard the aircraft, or at the hospital.
“Overall, they’re not just paying that 250,” the representative said. “It doesn’t include treatment. Whatever they’re doing to them inside the ambulance, or whatever they do to them after the fact that they got dropped off, that will probably be its own separate bill.”
Christie, an account sales representative with AirMedCare Network, said their membership covers both the costs of the flight, and treatment received on the aircraft, with no copay.
“If you’re ever airlifted by us, we will bill your insurance or whoever is responsible to pay for your medical care,” she said. “We’ll take what they pay as payment in full, then the membership covers the rest.”
Christie’s advice that the flight would be covered, as well as treatment performed onboard, could not be independently verified.
Global Medical Response is the holding company over the program, and Shelly Schneider, Director of Public Relations, said she is not sure if HEART is considered a “traditional model,” meaning the helicopter, pilot and mechanic are provided, but the medical crew would come from the hospital. This would generate two separate bills.
“Or if it’s a community-based model—so Air Evac Lifeteam is also in Tennessee, and those are community-based models,” Schneider said. “So Air Evac has the pilot, the mechanic and the med crew – the nurse and the paramedic – and so that might be billed differently.”
Schneider said she would find out how HEART and UT LIFESTAR are billed, but did not follow up by the time of publication.
Federal data being collected on air ambulance services could shed light on the other unknown or lesser known costs associated with air ambulance services in the future, according to the September HHS report.
The department stated that information would be used in a comprehensive, publicly-available HHS and Department of Transportation report to increase transparency and help inform future policy development aimed at addressing these costs.
This story appeared in The Newport Plain Talk.