Ken Alltucker, The Republic | azcentral.com
4:32 p.m. MST January 13, 2016
With her husband's life fading from a stab wound to the head, Laura Brown's only thought was how quickly she could get to his side.
She was in Scottsdale. He was at a Yuma hospital.
On the road to Yuma, she got a call. Her husband, Bruce, was being flown by medical helicopter to St. Joseph’s Hospital and Medical Center in Phoenix. His brain stem had been severed. A day later, he was pronounced dead.
In the days and weeks after the March attack, Brown mourned the loss of her husband. She also lost her son, Blake, 25, who is mentally ill and was responsible for his father's fatal injury. Blake has been placed in long-term confinement at the Arizona State Hospital.
Then, the devastated wife and mother faced a new and lingering pain: a costly and unexpected air-ambulance bill.
While Brown's case appears to be headed toward a satisfying resolution, other consumers around the nation routinely face sticker shock when confronted with air-ambulance bills.
Brown's husband’s health insurer largely covered the cost of his hospital care, and she paid the portion that the insurer did not.
But that wasn't the case with the air-ambulance company. Tristate Care Flight’s transport, which her husband could not consent to and she was not made aware of before takeoff, resulted in a $64,620 bill.
Brown’s insurance company, Ameriben, has already paid Tristate Care Flight $19,909. Ameriben told Brown that the Bullhead City-based air-ambulance company was not part of the insurer's network of providers with set, negotiated rates, but it agreed to pay about twice the rate that Medicare would have paid for a similar trip.
Tristate Care Flight wanted Brown to pay the rest of the bill: $44,711.
Though Brown's appeal to her late husband’s insurance company to pay a larger portion of the bill so far has been unsuccessful, this story appears to have a happy ending for Brown.
After The Arizona Republic contacted John Cole, chief operating officer of Tristate Care Flight, to discuss the company's billing practices, he began investigating the case. On Wednesday, Brown said, he notified her that if the company is unable to secure additional insurance payments, it would write off the balance of the bill and that she would owe nothing.
Cole would not divulge details of his conversation with Brown, but said, "I am helping her out with her situation. She is very happy."
Air-ambulance billings are complicated. According to Brown's bill, Tristate Care Flight charged a base rate of $17,325 for the one-way helicopter transport. It also charged $289 for each mile of the 163-mile trip. The base charge and per mile charge made up the bulk of the bill, which included four other minor charges.
Brown isn't the only consumer surprised by air-ambulance bills.
In 2014, the National Association of Insurance Commissioners (NAIC) issued a consumer alert about the cost of and coverage for air-ambulance bills, in part, due to consumer complaints and feedback from state insurance commissioners, an NAIC spokeswoman said.
The NAIC alert said that the average air-ambulance trip is 52 miles and costs from $12,000 to $25,000 per flight.
Other estimates suggest that these emergency medical trips may cost more. FAIR Health, a database of nationwide insurance claims that provides a search tool for consumers, estimates that a Phoenix resident can expect to be billed $25,678 for a one-way air ambulance trip, plus a charge of $283 per mile.
These bills can catch consumers off guard because health insurers may not cover all charges and may require consumers pay a significant portion. Consumers often are not in a position to refuse service or negotiate rates because these medical helicopters typically are dispatched only for medical emergencies.
Some experts say that air-ambulance bills raise an important health-policy question: Who is financially responsible when a health provider seeks to recoup full, charged rates, even beyond what an insurance company is willing to pay?
"There is a lot of discussion about balance billing," said Dr. Daniel Derksen, director of the Arizona Center for Rural Health at the University of Arizona.
Derksen said consumers need to read and understand what their insurance policies cover, but he added that it can be difficult in an emergency, when a medical helicopter is required.
"You can't say, 'Let's see if this is a covered benefit or not,' " Derksen said. "When you are making decisions that can affect someone’s health outcomes, normally you do what's in the best interest of the patient and you sort through the details of who is going to pay for it later."
Perhaps anticipating resistance from Bruce Brown's insurer, Tristate Care Flight mailed a letter to the Browns' Scottsdale home within two weeks of the emergency transport. Tristate offered to help file an appeal to compel the insurance company to pay a larger share of the bill.
Cole said billing complaints are common in the air-ambulance industry.
“This happens all the time,” Cole said. “It is something we work with each individual patient. It is not our goal to put anybody in a position where they are unable to pay. We just want to provide good care.”
Cole added that operating an aircraft with pilot and a trained crew available 24/7 is an expensive proposition. Crews and an aircraft must be available at a moment's notice to respond to car crashes and other medical emergencies across the company's four-state territory. And a medical aircraft may cost as much as $6 million, according to the NAIC bulletin.
Tristate outsources its billing to a third-party company, and Tristate often writes off bills that it is unable to collect, Cole said.
Tristate Care Flight was founded in 2002 by Bullhead City orthopedic surgeon Blake Stamper, also a pilot, who saw the need for a quick response for injured patients, according to the company's website.
Last November, Tristate Care Flight agreed to sell the business to Air Methods Corp. in a $222.5 million deal. A news release announcing the merger said that Tristate had revenue of $81.5 million in 2014.
Brown questioned why the air-ambulance company was able to charge her even though her husband could not provide consent. His brain stem had been severed and he showed little evidence that he would survive the injury. Brown was not made aware of the transport until the helicopter was on its way to Phoenix.
Cole said that such discussions rarely happen during an emergency. The top priority of the flight crew is to make sure the patient gets proper care.
"We just get going, that's the bottom line," Cole said.
After Bruce Brown was discovered stabbed at his home in Yuma, he was transported to Yuma Regional Medical Center. Yuma doctors determined he needed to be treated at a hospital that offered more-advanced care, so they called for an air-ambulance transport.
The hospital typically does not investigate whether a patient's insurer has a negotiated contract with an air-ambulance company. The hospital's priority is to find a transport company with an available aircraft, pilot and crew that can respond quickly, said a Yuma Regional spokesman.
Although Ameriben has negotiated contracts with other air-ambulance companies, the hospital called Tristate Care Flight that day. Ameriben uses Blue Cross Blue Shield's network of providers. Air Methods, the company that is purchasing Tristate Care Flight, has a contract with Blue Cross.
For Brown, the air-ambulance bill capped a heartbreaking scenario. With Wednesday's news, she hopes she can now move on.
"This could have been life-altering," Brown said of the bill. "I'm thankful."