Both air and ground ambulance services have been center stage in the national fight over huge surprise bills, since the for-profit companies that run them frequently do not participate in insurance networks.
$489,000, most of which was for the flight from Denver, with approximately $70,000 for the ground ambulance service to and from the Denver and Raleigh-Durham airports.Insurers generally get to decide what care is “medically necessary” and therefore covered. And that is often in the eye of the beholder.
On that day, Angel MedFlight flew Deines to North Carolina in an airplane, along with a nurse to oversee his IV medications and oxygen levels. At the end of December, an appeal was filed against that decision on behalf of Deines by Angel MedFlight. Then, three months after Blue Cross sent the check that Deines then sent on to Angel MedFlight, the insurer demanded Deines pay back the $72,000.Medical necessity criteria are set by insurers, with North Carolina Blue Cross covering air ambulances in “exceptional circumstances,” such as when needed treatment isn’t available locally.
His health plan “clearly stipulates their indications for medical flight coverage and, unfortunately, this case does not meet that criteria,” the review concluded.The bill disappeared only after the press got involved. Shortly after a KHN reporter contacted the communications representatives for both the insurer and Angel MedFlight, Deines heard from both of them.
Still, there’s good news for Deines: Both the insurer and the air ambulance company told KHN he will not be held responsible for any of the charges.
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