BERLIN — When a Berlin child with a critical illness was flown to a Baltimore hospital last October, her parents did not know that 45-minute flight was the beginning of a nearly year-long journey including a battle with the private sector air ambulance service over exorbitant fees and a multi-pronged effort at reform.
Last Oct. 10, life changed quickly for Berlin residents Steve and Jayme Isett when the couple’s then-5-year-old daughter Sarah was flown from Atlantic General in Berlin to Johns Hopkins in Baltimore in critical condition with acute renal failure. Sarah was taken to AGH when she complained of not feeling well and after a battery of tests on the child, it was determined she needed specialized care for a critical condition provided by only a handful of hospitals in the region.
In order for Sarah to receive immediate healthcare from a pediatric nephrologist, the emergency room doctor at AGH made arrangements with the private-sector Air Methods Corporation to fly the child via helicopter to Hopkins in Baltimore. Hopkins Hospital’s regular non-profit vendor was on another call and not available, so the AGH doctor made arrangements with Air Methods to transport Sarah to Baltimore in those critical, but potentially life-changing moments.
What the Isetts didn’t know in those critical moments is that the 45-minute helicopter flight from Berlin to Baltimore would cost them $55,000, or roughly the same amount as her entire three-week stay at Hopkins including the operating room and the intensive care unit.
Sarah was treated and ultimately recovered and her long-term prognosis is good, which, of course, is a blessing to say the least, but the Isetts are still trying to recover from the shocking $55,000 bill from Air Methods for the emergency 45-minute helicopter flight that October afternoon. Unfortunately, theirs is a plight similar to many on the Eastern Shore and other rural areas that don’t have quick and easy access to medical specialists often hours away. With time and distance so critical, helicopter transport is often the only way to rapidly get ill or injured patients to the care they immediately need as many on the Eastern Shore have come to learn. For the Isetts, it was the only choice with their 5-year-old daughter in critical condition but it came with a steep price tag.
The Isetts’ private insurance provider, Blue Cross-Blue Shield, paid Air Methods about $26,700, or the maximum amount allowed under their plan, leaving them accountable for the rest, or about $28,000.
“It was just insane,” said Jayme Isett this week. “The amount they charged for that 45-minute flight was about three times as much as Hopkins’ contracted vendor would have charged. We just feel like it was price-gouging at its worst because they knew we were vulnerable and had no choice. It’s not like you’re going to get a quote when you’re waiting for a helicopter to arrive to transport your sick child.”
A year-long battle with Air Methods over payment has since ensued.
“We were sent a notice that we had an outstanding balance of $28,000 and we were going to be sent to collections if we didn’t pay,” said Isett. “They asked for two months of our bank statements, but we weren’t comfortable with that, so they came back with ‘just give us $11,000 right now and we’ll call it even.’ They said we could pay it off at $275 per month for the next 60 months.”
When the Isetts asked for that offer in writing and told Air Methods they wanted to consult first with their lawyer, they were told just last week they could pay $212 per month for the next 60 months, or five years, until the balance is paid off in what was essentially becoming a “Let’s Make a Deal” situation. For the time being at least, the Isetts are beginning that payment plan, but they are currently exploring several options for their own plight and for others across the shore and other rural areas often left at the mercy of private sector medical transport companies.
“We know there are a lot of people on the shore and throughout Maryland that are going through the same thing and it’s just extremely unfair and unfortunate,” she said. “We’re hoping to find people in the same situation and maybe there can be a class action suit. I’m not sure where this part is heading, but we’re going to explore it if there are more people in the same boat. We just feel like they are taking advantage of people when they are the most vulnerable.”
Isset said she reached out to Maryland Gov. Larry Hogan and received a response from his office sympathizing with their situation but essentially saying the state’s hands are tied. Air Methods and similar air ambulance service providers are protected under the Federal Aviation Act of 1978 and their rates were deregulated decades ago, essentially leaving them free to charge whatever they want.
“As far as the state goes, there is very little that can be done because they are protected under federal law,” said Isett.
Isett also mentioned other states including neighboring Delaware have balanced billing laws on the books that insulate consumers somewhat from exorbitant charges for medical services. Maryland currently does not, but Isset said she has reached out to Senator Jim Mathias’ office for a possible legislative recourse. Mathias’ office interceded on the Isetts’ behalf with the Maryland Insurance Administration but again, they were told there are no options for pursuing a claim under Maryland laws.
“It’s an issue of great concern,” he said. “We’ve been working with the Maryland Insurance Administration and I know Carefirst has come forward in the last year or so and taken the effort to cover the air ambulance fees. It’s a serious consequence and we’re working through it. We have families in a position of making these decisions at the most critical times and to then get hit with bills totaling tens of thousands of dollars is unacceptable.”
As far as any legislation remedy in Maryland, Mathias said he was willing to explore any and all options.
“In a general sense, I’m totally dedicated to rural healthcare delivery,” he said. “We’re challenged in rural areas because of the proximity of specialized hospitals. We have the trauma center at PRMC and they do a wonderful job, but there are times when a patient need specialized care and they have to be flown across the bay. The thing to remember is these transports are on the advice of the doctor and they make the decision based on the condition of the patient and the medical resources immediately available. If your doctor recommends a transport, you’re going to take that advice without regard for the potential cost.”
However, there was some good news from Mathias’ office. Isett said she was told the Berlin family’s plight has been the catalyst for the Maryland Hospital Association, CareFirst and Johns Hopkins Hospital reviewing health care facilities’ protocols for medical transport in an effort to ensure similar situations don’t arise for other families in the future.
For the time being, the Isetts continue to explore any and all means to prevent similar medical transport price-gouging issues in the future. Jayme Isset said this week her next call might be to the Maryland Attorney General’s Office to explore other remedies. Through it all, the Isetts don’t hold AGH at fault, or their insurance company, Blue Cross-Blue Shield, which they receive through the Worcester County Public School System as Steve is a teacher.
“We have no gripe with AGH,” she said. “They did everything they could for Sarah before it was determined she needed specialized care and needed to be transported. We don’t have a problem with the insurance company either. They paid about half, which was all that was allowed under our plan, but it should have more than covered if the final bill wasn’t three times higher than it should have been.”
Air Methods did not respond to multiple requests for comment, but the company’s position is spelled out clearly in an official statement released in March following a scathing report on ABC News regarding its allegedly exorbitant fees for medical transport. The report outlined several cases similar to the Isetts, including a $46,800 bill for an 85-mile flight to a hospital for a victim in Las Vegas and another for a $47,000 flight to a hospital 25 miles away for the family of a young victim in Kentucky among many others.
In response to that report, Air Methods released a statement outlining the company’s cost to provide the service and the inability of the victims’ families in many cases to pay.
“When transported, these patients are in such critical condition, we have to continue care in the air,” the Air Methods statement reads. “We’re, in essence, a flying emergency room and we only respond when a physician or first-responder calls us. When every minute counts, emergency air medical transport and treatment is often not the best choice for saving a life, it’s the only choice.”
The Air Methods statement goes on to attempt to justify the seemingly exorbitant fees because their crews are on alert all day, every day, not if but when they are needed.
“Like a fire station, our fleet and highly trained clinicians are always ready to deploy every moment of every day, whether there is an emergency or not,” the statement reads. “Yet, real-time deployment readiness requires enormous financial resources and ongoing investment. There is a very real cost that goes into providing access to lifesaving services 24 hours a day, seven days a week and 365 days a year.”
Isett suggested Air Methods and similar air medical transport companies review a patient’s insurance company when determining what to charge. She said the companies appear to overcharge private insurance carriers to offset the cost of those with government-subsidized insurance with capped payouts. It remains uncertain if that sentiment is true, but Air Methods statement released in March appears to indicate it is at least a consideration.
“When we are asked to save a life, we deploy without regard to a patient’s ability to pay,” the statement reads. “That means we sometimes don’t receive payment for our services. And when we do, the payments we receive for Medicare and Medicaid patients don’t come close to covering the actual cost we incur for providing our service. This means we are essentially losing money on seven out of 10 transports due to extremely low government payments.”
It remains to be seen if the Isetts find similarly situated families facing the same exorbitant helicopter transport fees in the local area or across the state, or if they would pursue a class action suit even if they did, but there is certainly precedent for it. Last year, a class action suit was filed in federal court in South Carolina against Air Methods and its subsidiaries for the same reasons. The suit’s primary plaintiff was a South Carolina man injured in an automobile accident that was transported by an Air Methods subsidiary to a hospital 25 miles away to the tune of nearly $31,000. The suit asserts the fees charged by the company were exorbitant and represented a breach of implied contract.
“By any measure, the prices charged by the defendants to the plaintiff and members of its class for hospital services were unreasonable,” the complaint filed in the South Carolina suit reads.
The suit was filed in April 2015 and is still bouncing up and down the litigation circuit with multiple claims and counter-claims filed. In its answer to the complaint, Air Methods through its attorneys suggest rates and fees are naturally not negotiated during a crisis and are figured out later.
“The unique and exigent circumstances surrounding emergency transport by air ambulance often limit the parties’ opportunity to engage in a traditional negotiation of contract terms,” the answer to the South Carolina suit reads. “The unique and exigent circumstances surrounding emergency transport by air ambulance often limit the parties’ ability to engage in a specific discussion about rates and price terms.”
In the meantime, Sarah Isett, now a first grader at Ocean City Elementary School, has recovered for the most part, while her family continues to seek air transport fee reform.
“Sarah is doing wonderfully,” said Isett. “I don’t know what the future will bring, but right now she is just a normal little girl.”
Last fall, when Sarah was going through her recovery period, a GoFundMe page was started to help the family cope with the unexpected expenses associated with her illness. In a short period of time, the community rallied and met the $5,000 goal.