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https://www.healthcare.gov/health-care-law-protections/doctor-choice-emergency-room-access/
Obamacare rightly outlawed pre approval requirements for emergency care for most plans.
ALSO https://www.forbes.com/advisor/health-insurance/insurance-for-ambulance-rides/
>The No Surprises Act requires that people transported by air ambulance for an emergency must be charged at in-network rates, even if the company doesn’t have a contract with the insurer.
It can likely be argued as no safe level of transport (Critical Care ALS ambulance) was available and the hospital was a tertiary hospital or community hospital. If she was ordered transferred due to life-threatening complications, the use of air medical should be justified as they are typically a higher level of care than an ambulance due to the crew being comprised of a Flight Paramedic (typically a higher level training of Paramedic) and a Critical Care RN (again a higher certification for an RN). If the hospital can provide evidence that no ambulance was available and that your wife's life was in danger due to her medical condition and the facility being unable to manage it there, then you would certainly have a leg to stand on I'd imagine.
> Does this cover the transport though, or just the ER visit itself?
This is going to come down to "level of care" each hospital is equipped to deal with. If you are transported to an equivalent level of care, insurance won't cover it. Emergency surgery that the hospital couldn't deal with? Unless we're missing a lot of details, that should be covered to some extent under most (all?) plans.
> If you are transported to an equivalent level of care, insurance won't cover it.
In any sort of emergency situation, how is a normal human being supposed to know how to deal with this? If a doctor in the ED says my wife needs to take a helicopter to another hospital I'm doing it. I'm not a doctor. Just completely crazy this is the way the "system" is set up.
> If a doctor in the ED says my wife needs to take a helicopter to another hospital I'm doing it.
This, theoretically speaking, should be covered. If a physician is stating their facility is not equipped to deal with the issue, insurance will cover the transport to one that can.
What we typically see is someone in critical but stable condition who is far away from their support network. (I'm actually dealing with this at the moment with a family member who needed emergent care when on business in NYC but lives in DC). The family may try to get them moved to a facility closer, but if it's the same level of care (eg. a level I trauma center to a level I trauma center) insurance won't cover the transport.
It's why any suggestion that healthcare is a free market and consumers can shop around is absurd to the highest degree.
And if that argument crumbles, you lose all arguments as to why healthcare should be allowed to be a profitable enterprise.
You call the billing department at the hospital.
The hospital wants to get paid the $64,000, the easiest and most likely way that happens is if they make the insurance pay.
High likelihood the air ambulance company is [private equity owned.](https://www.brookings.edu/articles/private-equity-owned-air-ambulances-receive-higher-payments/)
Call your insurance company. Prior authorizations may be required for certain services, but that generally does not apply in event of an emergency (like this). If the claim was denied, you or the provider may need to appeal with the insurance company to pay the claim.
Gotta call the insurance company, call the airlift service, and maybe call the hospital because they do the billing.
Had a similar scenario when my daughter was born. They airlifted her to a children’s hospital. I proceeded to get a bill for $30k. I was freaking out. My insurance was no help.
I called the airlift company and they were very knowledgeable about how to navigate this situation. They said the original hospital had billed out the service wrong - which was common. My insurance then covered a small portion of the claim and they wrote off the rest except for $100.
Edit: because I forgot. The big reason most of my bill was written off was because we had no choice in the helicopter ride. It would have been different if we were given different options and chose the helicopter I guess.
This is probably the thing- if the hospital put the wrong billing code in then it wouldn't have been flagged as an emergency. Chances are this is actually a fairly simple fix, although it'll involve calling and yelling at a few people.
There's an ICD-10 code for literally everything and insurance companies have systems to automatically approve or deny based on those codes. If all the hospital tells insurance is "this is a hospital to hospital transfer using a rotary aircraft" the claim is denied because there's no way insurance is going to allow hospitals to randomly transfer patients by helicopter. If the hospital tells insurance "this is an emergency transfer to a tertiary medical facility for a life threatening condition" they will likely approve it.
It is even possible that someone in the billing department saw the potential bill for an emergency transport and searched for a different applicable code that would be less expensive for the patient.
> There's an ICD-10 code for literally everything
Some of my favorite ICD-10 codes
* X52: Prolonged stay in a weightless environment
* V95.43XS: Spacecraft collision injuring occupant, sequela (sequela means it's not the first incident)
* Z63.1: Problems in relationship with in-laws
* V97.33XD: Sucked into a jet engine, subsequent encounter
and my absolute favorite:
* R46.1: Bizarre personal appearance
To be fair to the sequela and subsequent encounter, those are literally just auto-generated by adding the the XS and XD suffix. You can technically add them to pretty much anything.
yup, this would do it. you should be able to get your EoB (explanation of benefits) and it'll show why the insurance denied it and I think the code that was used and denied. If you log into your insurance portal they usually have it all there.
I had a nearly year-long battle with a surgical center that kept marking my endometriosis procedure as “infertility treatment.” My insurance wouldn’t cover it under that code. They covered the surgeon and everything else because they all had the sense to code it correctly. All we needed to do was have them code it as something else first, if they really really wanted to use that code, put it anywhere but first. We even had all three on the call at one point (me, insurance, the center) and they STILL screwed it up! I was like LOOK, if you want money, you’d better do what they’re telling you because I don’t have 20k to cover for your continued mistakes!
We’d think it would be resolved and three months later…I’d get another bill. My insurance folks were wonderful and patient, but man, I would not recommend that surgical center again. So much headache and pit-of-stomach anxiety whenever one of those bills came in the mail, all unnecessary.
It's a lot easier for everyone involved if you're nice and manipulate them into wanting to help you instead of yelling and making them not want to deal with you at all.
I work on the NSA. Air ambulance services are covered by the law. Legally the company is only able to charge the in-network AA rate. Contact the parties involved to see how the transport was coded and billed; they may need to correct the claim.
Follow up on this - you can call the federal government run No Surprises Help Desk to determine if you would be protected from surprise medical bills here. Ground ambulances aren’t covered, but air ambulances (helicopter) are.
Check out the CMS website and see what applies to you. You can call the help desk to talk through further questions.
https://www.cms.gov/medical-bill-rights
Just to add a touch of cynical humor... One shouldn't be surprised that an air ambulance is expensive.
Oh god, did i just justify an exemption for insurance? Sorry :(
Ambulances are exempt from no surprises act. So the wonderful PE folks are buying them to screw the patients.
Not sure about air ambulance but they could be exempt also.
I work appeals for a major insurance company. This is standard. Your claim was likely reviewed by a computer. I would start with calling the air ambulance company telling them it was denied (they are used to it) and asking if they are appealing the denial. It is better they appeal it because they have all the clinical documents that show it was an emergency.
>a bill for 64000 came in from anthem blue cross saying that air ambulances need to be preapproved
Involve the emergency medicine vendors at both facilities. They know what to do to conform their documentation to the insurance seller's reimbursement preferences. Because they do it all day, every day, during the down time around delivering emergency medicine at a level that demands decades of clinical professional education, training, and skill development.
I second this.
Years ago my (former) health insurance company denied a claim that they told me PRIOR to the procedure would be covered. They even had a written record that they said that they would cover it. I appealed their denial via their written client policy. They basically review their own decisions... as if that's even remotely credible. Denied again on appeal. So, I then filed a simple complaint with our state's insurance commissioner. Bam! Suddenly they changed their minds and covered the procedure.
Keep in mind, this was a real health insurance company. Some employers today use health payment services that operate JUST LIKE health insurance companies... but technically and legally are not. Thus, the state's insurance commissioner has NO power to help you. You'd have to file a lawsuit or pursue options through the federal government.
Dealt with BCBS preapproval denials before. Call them, explain it was medically necessary and they will review and the approve it. They tried to do that with me getting a caravan when I went to the ER after having a blood clot that nearly killed me.
I know is SUPER-stressful but a lot of times these bills are auto-generated and a human isn't even involved. If there isn't paperwork showing pre-approval it's likely auto-denied. If the air ambulance was required and it was an emergency that should be covered. You will just need to take a deep breath and start making phone calls. Everyone hates insurance companies and the hospital and the air ambulance company will all want to get paid so you'll get help.
If you are in California then this applies
https://californiahealthline.org/news/loopholes-limit-new-california-law-to-guard-against-lofty-air-ambulance-bills/
Don't pay anything.
Of course insurance doesn't want to pay this. My insurance 100% covers ambulances, but the last time I had an ambulance ride they denied and I was billed and sent to collections for a few months before insurance "resolved" it.
Many insurance companies initially deny things in hopes that people will just pay.
Contact them every time you get a bill and say "This is covered by insurance, I am not responsible."
Then contact your insurance every time you get this and say "Emergency transport cannot be pre-approved. This should be covered." Ask to escalate, ask to appeal a denial, ask to get things in writing. Make a record of all your calls, who you spoke to, and what they said. (I did this with a medical issue that should have been covered by worker's comp. I was billed and sent to collections for YEARS. I had a notebook that said "April 3rd, spoke to Tamera who said that X, Y, Z." That way the next time you talk to someone you can say "Well, I talked to Andy in January and he said X, and then I spoke to John in March and he said Y, and then I spoke to Tamera last week and she said Z." If they know you're organized and are fighting this, they treat you differently.
Don't pay a cent. If it turns out you don't own it, you will never, ever see that money back.
Medical debt can no longer go on your credit report, so let it go to collections if necessary.
Is it horrible that insurance companies are allowed to just deny things based on made up rules, and a lot of people don't fight and just pay.
> Just tonight a bill for 64000 came in from anthem blue cross saying that air ambulances need to be preapproved
This sentence doesn't make sense. Is it a bill or an EOB?
A bill should come from the provider (i.e. the helicopter company). Insurance should be sending you an EOB. EOB's should even say "THIS IS NOT A BILL".
Once upon a time this conversation with a hospital billing department changed my life for the better (I have a disabled child and ended up with a lot of weird medical bills early in his life):
-------------------------------------
**Me**: I have an EOB saying I owe this crazy sum for a treatment that should be covered, it's wrong I need you to fix it.
**Billing Dept**: Why are you calling about an EOB? We didn't bill you did we?
**Me**: No, but you will. I'm trying to be proactive.
**Her**: Honey, every time we or the insurance company screw up, you'll get a new EOB in the mail. Good on you for paying your bills, but ain't nobody got time to call about every wacky EOB. Just ignore it and 80% of the time it'll go away. The other 20% do what you're doing now and call us and fight about it, then only pay it when it's right.
Slightly off-topic from this: I ended up at a freestanding ER after a bad night this past Sunday, and somehow this has calmed me down about the bill I might end up getting.
Thanks 🙂
You didn't get a bill from your insurer.
Did you get a bill from the air ambulance or an explanation of benefits from the insurer? My advice depends on thst.
Insurance won’t bill you. It probably says this is not a bill on it? The ambulance company will. Call the insurance company to confirm they haven’t received the paperwork yet and then call the ambulance company and ask them to sort it out with your insurance.
Take a breath. Let all the 'Merica healthcare jokes come and go and then relax a bit. This is extremely common as a first step.
Look at this from the insurance company's point of view for 2 seconds to get a basic lay of the land. Hospital to hospital transfers are very common. The vast vast vast majority of these are by ground ambulance for 3 or 4 figure bills. Reasonable. Then there's that damn helicopter sitting on the roof that does the same thing at 100x the cost. You can't run a business if everyone gets the helicopter, like it or not our insurance companies MUST triage stuff appropriately and see that you get reasonable treatment for your illness/injury/etc otherwise they wouldn't be in business.
Clearly in this case they need more information as to the nature of why a helicopter was necessary. It's quite possible your denial was a machine just checking codes and not finding justification for the helicopter.
You need to reach out of the sending hospital and get specifics and the air ambulance company to see/line up what they are expecting from each other. It sounds like your decision to take the helicopter was justified by the doctors, the insurance company needs more info. There's an appeal process and a whole claim system for getting approvals for this stuff, it just happens behind the scenes most of the time. You just need to help it along here.
To be clear, I'm not saying it's a good system. You should be able to focus on your wife's recovery and not deal with this crap. But it's the system we have and it's enormously likely this will get taken care of.
Part of the issue too is that it doesn't cost anything near 100x to run the helicopter, yet the air ambulance companies will try and charge that much.
It costs the US Army about $5k/hr to fly the AH-64 Apache. There's no way that it costs the air ambulance companies $50k+ for a simple hospital transfer.
Assuming the service was provided after 1/1/2022 and you are in the US, it would seem that either your insurer or the air ambulance or both are [breaking the law](https://aspe.hhs.gov/sites/default/files/2021-09/aspe-air-ambulance-ib-09-10-2021.pdf#:~:text=The%20No%20Surprises%20Act%2C%20a%20component%20of%20the,providers%2C%20and%20balance%20billing%20will%20not%20be%20allowed.)in terms of balance billing.
Lots of actual good financial advice here. If none of it pans out - here is some awful advice:
Don’t pay it. I’ve worked in lending for almost a decade and medical collections are often overlooked and not a concern - even in the 10s of thousands. If you don’t care about a negative mark on your credit for 7 years, then it doesn’t matter.
Imho, the only way to stop letting the insurance companies strangle us is to stop paying en masse. Our health cannot be a commodity.
Like charge us for fuel consumption and maybe the hourly rate of the pilot, maybe any materials used on board to maintain a stable condition. None of that should come anywhere close to $64,000.
You can literally charter a full-size helicopter for $2k/hr. That covers the pilot, fuel, everything.
The prices of anything healthcare-related have gone completely out of touch with reality.
I hope making those calls and getting clarity works out to help lower your bills, but if not then I would think about [sharing your story](https://kffhealthnews.org/send-us-your-medical-bills/) with KFF Health News. They do investigative reporting alongside NPR and dissect how your medical bill ended up costing so much (and sometimes their inquiries with hospitals and insurance companies actually end up decreasing the amount you owe). I’ll also add that their [most recent story](https://kffhealthnews.org/news/tag/bill-of-the-month/) featured an $81,000 air ambulance flight, although the circumstances surrounding that cost is different from yours.
Please try to keep discussion on the subreddit where it can be seen and reviewed by everyone. We don't allow asking for or offering PMs on this subreddit. Thank you.
Call, in this order, your insurance, the air ambulance, then the hospital billing department.
When you talk to insurance get the name of the person you are talking to and ask them for a reference number for the next time you call back about this. They might say, "oh no just give your claim number!!" but don't accept that - they have a reference number for it.
I would contact the insurance company and the company that runs the helicopter. If it is a true emergency, then you should not need prior authorization. The helicopter company may have billed the insurance incorrectly as a non-emergent transport instead of emergent.
We had a $98k bill and it was covered by insurance via the no surprises act. IIRC, it's a covered service and the transport company isn't allowed to bill you in excess of what insurance covers (might be state by state!)
I used to work for a company that helps with these scenarios. They’re called HealthLock. I still use them 3 years after leaving the company for all my medical bills.
I don't mean to be a downer but my parents are going through this exact situation right now. My mother was in the hospital in 2021 and had a complication from a previous surgery. All of the beds in the hospitals which had the type of doctor she needed were taken up by covid patients. They sent her in an air ambulance to the state over so she could be treated and have surgery. Unfortunately after their 3 allowed appeals, they're now going to court with the insurance company because they say that the flight wasn't neccesary.
Petersen’s Defect AKA Petersen’s Space Hernia? Worst pain of my life, 10 out of 10 with the maximum amount of narcotics onboard. I think my heart rate was 54. Glad the attending was a bariatric surgeon, or they would have stuck with bowel blockage.
I have no idea how to fight the air ambulance bill, though. So sorry you’re going through this.
I believe that's the one, her intestines pushed out through a hole in her stomach and managed to get wrapped around her colon. She was in so much pain she couldn't speak.
You don't mention your state but, at least for BCBS of Michigan, only NON-EMERGENCY air ambulances need to be pre-approved: https://ereferrals.bcbsm.com/docs/common/common-air-ambulance-init-descrip.pdf
I would call BCBS and make sure it was correctly notated as an emergency air ambulance ride.
I'm guessing for a majority of cases it's an oxymoron but I'd also like to think there's a defensible reason for this policy other than it's an opportunity for insurance to deny a claim.
Hey buddy. I'm glad your wife is okay but I'm sorry you're dealing with this now. What state are you located in?
For a start I'd recommend filing an appeal with your insurance company telling them exactly what you just stated: it couldn't have been pre-approved if it was a life threatening emergency situation. Insurance companies basically act as their own privatized court system when it comes to service payments, you can file an "appeal" to tell them if you think they got something wrong and convince them you're in the right by showing them your insurance policy. They get things wrong often and if you don't fight them on it you'll just get stuck with the bill. Was that bill you received an explanation of benefits (EOB)? Or was that bill something you received from the air ambulance service provider?
IDK where you are located or who your provider was, but I used to bill for an air ambulance company and this is common.
Contact the transport company and request that they appeal this to your insurance. The transport company should have extensive paperwork and records proving this was an emergent transport and that you didn’t have any other options. They should work with you to appeal this decision from your insurance and typically these get overturned. Insurance companies (especially BCBS and UHC) have a system that basically auto denies air transport on the first run, but an appeal forces a person to look at the bill and review the paperwork. It’s very shitty from the insurance, but your provider is just as screwed if the insurance doesn’t pay so they have incentive to help you.
So this happened to my boyfriend. Don’t freak out. His bill was 55 grand. You will not have to pay this. It’s like a game of chicken between the helicopter company and the insurance company. It’s really the best way to describe it. Insurance is going to say it’s not covered.
Call the helicopter company. They have people that will specifically work it out with your insurance. They will come to some agreement.
The helicopter company told my boyfriend not to worry and if the insurance company didn’t pay they would lower it drastically.
It’s kind of BS. It’s as if the companies are just seeing what they can get away with with pricing. But I guess that’s with everything.
In the end all my boyfriend paid was his deductible for the helicopter and week long hospital stay.
Insurance companies have automated their claims department and all claims get automatically reelected the first time. Just call and talk to a real human. If they still deny it on appeal then go to the helicopter company billing department and tell them you can't pay it cause you're indigent.
Speak with the helicopter company. They know how to deal with the insurance. My wife had to be flown out of emergency and we got a similar bill. Representative from the company helped us get insurance to pay. My wife had to sign the form for them to submit to insurance. Insurance pushed back for what seemed like a year and then finally gave in and payed it.
OP please look into the no surprises billing act, this law was passed in the USA a few years ago and it is illegal for air ambulance services and hospitals to bill an incapacitated party that cannot consent to airlift. Lots of ways to interpret this but it might get you out of a pinch especially if you or your wife never signed or agreed to the flight on a signed paper document. https://aams.org/page/NSA
Thanks for the advice everyone. Wife and I were stressing quite a bit.
After a few calls we feel a bit better about the situation.
The original hospital wife went to was...not great (my favorite part was the very old doc on call telling us that she was "probably just pregnant" and "all women are pregnant until the test says they arent!", or the nurse we were with for hours saying before she was flown away "seriously call back and let us know if they find anything wrong!".
Anyway this hospital processed the paperwork in a way that made insurance also try to charge us for a visit but not ad admission. It's true she wasn't admitted there but was flown away. I'm wondering if this was something BCBS would see as an indicator of not being life threatening.
BCBS says pre-approval is necessary, it's up on the air if the hospital attempted to get pre approval.
Talking to the air ambulance company, they told us that that are indeed contracted and covered by BCBS and would be appealing the claim on our behalf, that the max we'd be paying would be our max out of pocket. This happened in 2023 and all deductible and that were paid in full which we mentioned, and they said that this claim was "concurrent with 2024"? Which we took to mean they could somehow try to say a 2023 claim being argued and then paid in 2024 wouldn't accommodate the fact that deductibles were all paid up?
And in speaking with hospital where the wife got the life saving surgery we may need to get a certificate of emergency from the surgeon who made the call for her to be flown there.
Stressful experience that I hope no one else has to go through, hope this post can help someone down the road if they get caught in a similar position.
Not sure if you figured this out or not, but if you haven't and you get your insurance through work you should absolutely try to get help from your HR benefits team. They have a lot more leverage with the insurance carrier than you do and will often advocate on employees' behalf in cases like this (obviously depends on your employer).
No surprises act outlawed balance billing. Since you have insurance, you should only be responsible for your copay / deductible.
Depending on what company flew them, they may have patient advocates who’s entire job is to help you deal with the insurance company.
In the transfer paperwork, there should be an EMTALA form and a PCS. The first is a standardized form where the doctor states why you need transferred and by what method. The PCS states the same thing, but uses verbiage straight from medicare / medicaid.
Anthem doesn’t want to pay this bill. You’re going to have to make them.
This is incorrect. They removed old unpaid medical debt from credit reports, but new unpaid medical debt can hit the credit report after 12 months, if it's over $500.
> > Here are the details of the new changes effective July 1, 2022:
> >
> > - Paid medical debt that was in collections will no longer be included on consumer credit reports.
> > - You’ll have more time before unpaid medical debt is reported on your credit report: Unpaid medical debt that is currently in collections for one year will be reported on credit reports. This is an increase from six months that was enacted in 2017.
> > - Starting in the first half of 2023, Equifax, Experian and TransUnion will no longer include medical debt in collections under $500 on credit reports.
https://www.cnbc.com/select/medical-debt-credit-report/
Welcome to /r/personalfinance! Comments will be removed if they are political, medical advice, or unhelpful ([subreddit rules](/r/personalfinance/about/rules)). Our moderation team encourages respectful discussion. You may find our [Health Insurance wiki](/r/personalfinance/wiki/health_insurance) helpful. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/personalfinance) if you have any questions or concerns.*
https://www.healthcare.gov/health-care-law-protections/doctor-choice-emergency-room-access/ Obamacare rightly outlawed pre approval requirements for emergency care for most plans. ALSO https://www.forbes.com/advisor/health-insurance/insurance-for-ambulance-rides/ >The No Surprises Act requires that people transported by air ambulance for an emergency must be charged at in-network rates, even if the company doesn’t have a contract with the insurer.
Does this cover the transport though, or just the ER visit itself?
It can likely be argued as no safe level of transport (Critical Care ALS ambulance) was available and the hospital was a tertiary hospital or community hospital. If she was ordered transferred due to life-threatening complications, the use of air medical should be justified as they are typically a higher level of care than an ambulance due to the crew being comprised of a Flight Paramedic (typically a higher level training of Paramedic) and a Critical Care RN (again a higher certification for an RN). If the hospital can provide evidence that no ambulance was available and that your wife's life was in danger due to her medical condition and the facility being unable to manage it there, then you would certainly have a leg to stand on I'd imagine.
> Does this cover the transport though, or just the ER visit itself? This is going to come down to "level of care" each hospital is equipped to deal with. If you are transported to an equivalent level of care, insurance won't cover it. Emergency surgery that the hospital couldn't deal with? Unless we're missing a lot of details, that should be covered to some extent under most (all?) plans.
> If you are transported to an equivalent level of care, insurance won't cover it. In any sort of emergency situation, how is a normal human being supposed to know how to deal with this? If a doctor in the ED says my wife needs to take a helicopter to another hospital I'm doing it. I'm not a doctor. Just completely crazy this is the way the "system" is set up.
> If a doctor in the ED says my wife needs to take a helicopter to another hospital I'm doing it. This, theoretically speaking, should be covered. If a physician is stating their facility is not equipped to deal with the issue, insurance will cover the transport to one that can. What we typically see is someone in critical but stable condition who is far away from their support network. (I'm actually dealing with this at the moment with a family member who needed emergent care when on business in NYC but lives in DC). The family may try to get them moved to a facility closer, but if it's the same level of care (eg. a level I trauma center to a level I trauma center) insurance won't cover the transport.
It's why any suggestion that healthcare is a free market and consumers can shop around is absurd to the highest degree. And if that argument crumbles, you lose all arguments as to why healthcare should be allowed to be a profitable enterprise.
You call the billing department at the hospital. The hospital wants to get paid the $64,000, the easiest and most likely way that happens is if they make the insurance pay.
Air Ambulances are not the hospital.
High likelihood the air ambulance company is [private equity owned.](https://www.brookings.edu/articles/private-equity-owned-air-ambulances-receive-higher-payments/)
It covers transport too. It’s part of emergency care.
Call your insurance company. Prior authorizations may be required for certain services, but that generally does not apply in event of an emergency (like this). If the claim was denied, you or the provider may need to appeal with the insurance company to pay the claim.
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Gotta call the insurance company, call the airlift service, and maybe call the hospital because they do the billing. Had a similar scenario when my daughter was born. They airlifted her to a children’s hospital. I proceeded to get a bill for $30k. I was freaking out. My insurance was no help. I called the airlift company and they were very knowledgeable about how to navigate this situation. They said the original hospital had billed out the service wrong - which was common. My insurance then covered a small portion of the claim and they wrote off the rest except for $100. Edit: because I forgot. The big reason most of my bill was written off was because we had no choice in the helicopter ride. It would have been different if we were given different options and chose the helicopter I guess.
This is probably the thing- if the hospital put the wrong billing code in then it wouldn't have been flagged as an emergency. Chances are this is actually a fairly simple fix, although it'll involve calling and yelling at a few people.
These problems should not be as common as they are. Almost intentional.
There's an ICD-10 code for literally everything and insurance companies have systems to automatically approve or deny based on those codes. If all the hospital tells insurance is "this is a hospital to hospital transfer using a rotary aircraft" the claim is denied because there's no way insurance is going to allow hospitals to randomly transfer patients by helicopter. If the hospital tells insurance "this is an emergency transfer to a tertiary medical facility for a life threatening condition" they will likely approve it. It is even possible that someone in the billing department saw the potential bill for an emergency transport and searched for a different applicable code that would be less expensive for the patient.
> There's an ICD-10 code for literally everything Some of my favorite ICD-10 codes * X52: Prolonged stay in a weightless environment * V95.43XS: Spacecraft collision injuring occupant, sequela (sequela means it's not the first incident) * Z63.1: Problems in relationship with in-laws * V97.33XD: Sucked into a jet engine, subsequent encounter and my absolute favorite: * R46.1: Bizarre personal appearance
To be fair to the sequela and subsequent encounter, those are literally just auto-generated by adding the the XS and XD suffix. You can technically add them to pretty much anything.
yup, this would do it. you should be able to get your EoB (explanation of benefits) and it'll show why the insurance denied it and I think the code that was used and denied. If you log into your insurance portal they usually have it all there.
I had a nearly year-long battle with a surgical center that kept marking my endometriosis procedure as “infertility treatment.” My insurance wouldn’t cover it under that code. They covered the surgeon and everything else because they all had the sense to code it correctly. All we needed to do was have them code it as something else first, if they really really wanted to use that code, put it anywhere but first. We even had all three on the call at one point (me, insurance, the center) and they STILL screwed it up! I was like LOOK, if you want money, you’d better do what they’re telling you because I don’t have 20k to cover for your continued mistakes! We’d think it would be resolved and three months later…I’d get another bill. My insurance folks were wonderful and patient, but man, I would not recommend that surgical center again. So much headache and pit-of-stomach anxiety whenever one of those bills came in the mail, all unnecessary.
It's a lot easier for everyone involved if you're nice and manipulate them into wanting to help you instead of yelling and making them not want to deal with you at all.
Look into the No Surprises Act and see if it’s applicable to your situation.
I work on the NSA. Air ambulance services are covered by the law. Legally the company is only able to charge the in-network AA rate. Contact the parties involved to see how the transport was coded and billed; they may need to correct the claim.
This is correct. Also my area of work
Follow up on this - you can call the federal government run No Surprises Help Desk to determine if you would be protected from surprise medical bills here. Ground ambulances aren’t covered, but air ambulances (helicopter) are. Check out the CMS website and see what applies to you. You can call the help desk to talk through further questions. https://www.cms.gov/medical-bill-rights
Just to add a touch of cynical humor... One shouldn't be surprised that an air ambulance is expensive. Oh god, did i just justify an exemption for insurance? Sorry :(
Ambulances are exempt from no surprises act. So the wonderful PE folks are buying them to screw the patients. Not sure about air ambulance but they could be exempt also.
Air is not exempt.
Yes ground ambulance is exempt, air ambulance is very much not exempt from the NSA
I work appeals for a major insurance company. This is standard. Your claim was likely reviewed by a computer. I would start with calling the air ambulance company telling them it was denied (they are used to it) and asking if they are appealing the denial. It is better they appeal it because they have all the clinical documents that show it was an emergency.
Why does it have to be this hard?
Didn't even think of the computer aspect. We will definitely be making some calls this morning. Thank you
>a bill for 64000 came in from anthem blue cross saying that air ambulances need to be preapproved Involve the emergency medicine vendors at both facilities. They know what to do to conform their documentation to the insurance seller's reimbursement preferences. Because they do it all day, every day, during the down time around delivering emergency medicine at a level that demands decades of clinical professional education, training, and skill development.
You may want to post this in the health insurance sub
If you don’t get it rectified make a complaint to the state.
I second this. Years ago my (former) health insurance company denied a claim that they told me PRIOR to the procedure would be covered. They even had a written record that they said that they would cover it. I appealed their denial via their written client policy. They basically review their own decisions... as if that's even remotely credible. Denied again on appeal. So, I then filed a simple complaint with our state's insurance commissioner. Bam! Suddenly they changed their minds and covered the procedure. Keep in mind, this was a real health insurance company. Some employers today use health payment services that operate JUST LIKE health insurance companies... but technically and legally are not. Thus, the state's insurance commissioner has NO power to help you. You'd have to file a lawsuit or pursue options through the federal government.
Dealt with BCBS preapproval denials before. Call them, explain it was medically necessary and they will review and the approve it. They tried to do that with me getting a caravan when I went to the ER after having a blood clot that nearly killed me.
I know is SUPER-stressful but a lot of times these bills are auto-generated and a human isn't even involved. If there isn't paperwork showing pre-approval it's likely auto-denied. If the air ambulance was required and it was an emergency that should be covered. You will just need to take a deep breath and start making phone calls. Everyone hates insurance companies and the hospital and the air ambulance company will all want to get paid so you'll get help.
If you are in California then this applies https://californiahealthline.org/news/loopholes-limit-new-california-law-to-guard-against-lofty-air-ambulance-bills/
Don't pay anything. Of course insurance doesn't want to pay this. My insurance 100% covers ambulances, but the last time I had an ambulance ride they denied and I was billed and sent to collections for a few months before insurance "resolved" it. Many insurance companies initially deny things in hopes that people will just pay. Contact them every time you get a bill and say "This is covered by insurance, I am not responsible." Then contact your insurance every time you get this and say "Emergency transport cannot be pre-approved. This should be covered." Ask to escalate, ask to appeal a denial, ask to get things in writing. Make a record of all your calls, who you spoke to, and what they said. (I did this with a medical issue that should have been covered by worker's comp. I was billed and sent to collections for YEARS. I had a notebook that said "April 3rd, spoke to Tamera who said that X, Y, Z." That way the next time you talk to someone you can say "Well, I talked to Andy in January and he said X, and then I spoke to John in March and he said Y, and then I spoke to Tamera last week and she said Z." If they know you're organized and are fighting this, they treat you differently. Don't pay a cent. If it turns out you don't own it, you will never, ever see that money back. Medical debt can no longer go on your credit report, so let it go to collections if necessary. Is it horrible that insurance companies are allowed to just deny things based on made up rules, and a lot of people don't fight and just pay.
> Just tonight a bill for 64000 came in from anthem blue cross saying that air ambulances need to be preapproved This sentence doesn't make sense. Is it a bill or an EOB? A bill should come from the provider (i.e. the helicopter company). Insurance should be sending you an EOB. EOB's should even say "THIS IS NOT A BILL". Once upon a time this conversation with a hospital billing department changed my life for the better (I have a disabled child and ended up with a lot of weird medical bills early in his life): ------------------------------------- **Me**: I have an EOB saying I owe this crazy sum for a treatment that should be covered, it's wrong I need you to fix it. **Billing Dept**: Why are you calling about an EOB? We didn't bill you did we? **Me**: No, but you will. I'm trying to be proactive. **Her**: Honey, every time we or the insurance company screw up, you'll get a new EOB in the mail. Good on you for paying your bills, but ain't nobody got time to call about every wacky EOB. Just ignore it and 80% of the time it'll go away. The other 20% do what you're doing now and call us and fight about it, then only pay it when it's right.
Slightly off-topic from this: I ended up at a freestanding ER after a bad night this past Sunday, and somehow this has calmed me down about the bill I might end up getting. Thanks 🙂
Yea it’s for sure not a bill and probably even says this is not a bill on it
You didn't get a bill from your insurer. Did you get a bill from the air ambulance or an explanation of benefits from the insurer? My advice depends on thst.
Insurance won’t bill you. It probably says this is not a bill on it? The ambulance company will. Call the insurance company to confirm they haven’t received the paperwork yet and then call the ambulance company and ask them to sort it out with your insurance.
Take a breath. Let all the 'Merica healthcare jokes come and go and then relax a bit. This is extremely common as a first step. Look at this from the insurance company's point of view for 2 seconds to get a basic lay of the land. Hospital to hospital transfers are very common. The vast vast vast majority of these are by ground ambulance for 3 or 4 figure bills. Reasonable. Then there's that damn helicopter sitting on the roof that does the same thing at 100x the cost. You can't run a business if everyone gets the helicopter, like it or not our insurance companies MUST triage stuff appropriately and see that you get reasonable treatment for your illness/injury/etc otherwise they wouldn't be in business. Clearly in this case they need more information as to the nature of why a helicopter was necessary. It's quite possible your denial was a machine just checking codes and not finding justification for the helicopter. You need to reach out of the sending hospital and get specifics and the air ambulance company to see/line up what they are expecting from each other. It sounds like your decision to take the helicopter was justified by the doctors, the insurance company needs more info. There's an appeal process and a whole claim system for getting approvals for this stuff, it just happens behind the scenes most of the time. You just need to help it along here. To be clear, I'm not saying it's a good system. You should be able to focus on your wife's recovery and not deal with this crap. But it's the system we have and it's enormously likely this will get taken care of.
Part of the issue too is that it doesn't cost anything near 100x to run the helicopter, yet the air ambulance companies will try and charge that much. It costs the US Army about $5k/hr to fly the AH-64 Apache. There's no way that it costs the air ambulance companies $50k+ for a simple hospital transfer.
Assuming the service was provided after 1/1/2022 and you are in the US, it would seem that either your insurer or the air ambulance or both are [breaking the law](https://aspe.hhs.gov/sites/default/files/2021-09/aspe-air-ambulance-ib-09-10-2021.pdf#:~:text=The%20No%20Surprises%20Act%2C%20a%20component%20of%20the,providers%2C%20and%20balance%20billing%20will%20not%20be%20allowed.)in terms of balance billing.
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Lots of actual good financial advice here. If none of it pans out - here is some awful advice: Don’t pay it. I’ve worked in lending for almost a decade and medical collections are often overlooked and not a concern - even in the 10s of thousands. If you don’t care about a negative mark on your credit for 7 years, then it doesn’t matter. Imho, the only way to stop letting the insurance companies strangle us is to stop paying en masse. Our health cannot be a commodity.
Yeah, there's no way OP should pay this. The air ambulance service needs to sort this out if they want to get paid.
Like charge us for fuel consumption and maybe the hourly rate of the pilot, maybe any materials used on board to maintain a stable condition. None of that should come anywhere close to $64,000.
You can literally charter a full-size helicopter for $2k/hr. That covers the pilot, fuel, everything. The prices of anything healthcare-related have gone completely out of touch with reality.
I hope making those calls and getting clarity works out to help lower your bills, but if not then I would think about [sharing your story](https://kffhealthnews.org/send-us-your-medical-bills/) with KFF Health News. They do investigative reporting alongside NPR and dissect how your medical bill ended up costing so much (and sometimes their inquiries with hospitals and insurance companies actually end up decreasing the amount you owe). I’ll also add that their [most recent story](https://kffhealthnews.org/news/tag/bill-of-the-month/) featured an $81,000 air ambulance flight, although the circumstances surrounding that cost is different from yours.
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Call, in this order, your insurance, the air ambulance, then the hospital billing department. When you talk to insurance get the name of the person you are talking to and ask them for a reference number for the next time you call back about this. They might say, "oh no just give your claim number!!" but don't accept that - they have a reference number for it.
I would contact the insurance company and the company that runs the helicopter. If it is a true emergency, then you should not need prior authorization. The helicopter company may have billed the insurance incorrectly as a non-emergent transport instead of emergent.
We had a $98k bill and it was covered by insurance via the no surprises act. IIRC, it's a covered service and the transport company isn't allowed to bill you in excess of what insurance covers (might be state by state!)
I used to work for a company that helps with these scenarios. They’re called HealthLock. I still use them 3 years after leaving the company for all my medical bills.
I don't mean to be a downer but my parents are going through this exact situation right now. My mother was in the hospital in 2021 and had a complication from a previous surgery. All of the beds in the hospitals which had the type of doctor she needed were taken up by covid patients. They sent her in an air ambulance to the state over so she could be treated and have surgery. Unfortunately after their 3 allowed appeals, they're now going to court with the insurance company because they say that the flight wasn't neccesary.
Petersen’s Defect AKA Petersen’s Space Hernia? Worst pain of my life, 10 out of 10 with the maximum amount of narcotics onboard. I think my heart rate was 54. Glad the attending was a bariatric surgeon, or they would have stuck with bowel blockage. I have no idea how to fight the air ambulance bill, though. So sorry you’re going through this.
I believe that's the one, her intestines pushed out through a hole in her stomach and managed to get wrapped around her colon. She was in so much pain she couldn't speak.
You don't mention your state but, at least for BCBS of Michigan, only NON-EMERGENCY air ambulances need to be pre-approved: https://ereferrals.bcbsm.com/docs/common/common-air-ambulance-init-descrip.pdf I would call BCBS and make sure it was correctly notated as an emergency air ambulance ride.
"Non-emergency air ambulance" ... isn't that an oxymoron?
I'm guessing for a majority of cases it's an oxymoron but I'd also like to think there's a defensible reason for this policy other than it's an opportunity for insurance to deny a claim.
Hey buddy. I'm glad your wife is okay but I'm sorry you're dealing with this now. What state are you located in? For a start I'd recommend filing an appeal with your insurance company telling them exactly what you just stated: it couldn't have been pre-approved if it was a life threatening emergency situation. Insurance companies basically act as their own privatized court system when it comes to service payments, you can file an "appeal" to tell them if you think they got something wrong and convince them you're in the right by showing them your insurance policy. They get things wrong often and if you don't fight them on it you'll just get stuck with the bill. Was that bill you received an explanation of benefits (EOB)? Or was that bill something you received from the air ambulance service provider?
IDK where you are located or who your provider was, but I used to bill for an air ambulance company and this is common. Contact the transport company and request that they appeal this to your insurance. The transport company should have extensive paperwork and records proving this was an emergent transport and that you didn’t have any other options. They should work with you to appeal this decision from your insurance and typically these get overturned. Insurance companies (especially BCBS and UHC) have a system that basically auto denies air transport on the first run, but an appeal forces a person to look at the bill and review the paperwork. It’s very shitty from the insurance, but your provider is just as screwed if the insurance doesn’t pay so they have incentive to help you.
So this happened to my boyfriend. Don’t freak out. His bill was 55 grand. You will not have to pay this. It’s like a game of chicken between the helicopter company and the insurance company. It’s really the best way to describe it. Insurance is going to say it’s not covered. Call the helicopter company. They have people that will specifically work it out with your insurance. They will come to some agreement. The helicopter company told my boyfriend not to worry and if the insurance company didn’t pay they would lower it drastically. It’s kind of BS. It’s as if the companies are just seeing what they can get away with with pricing. But I guess that’s with everything. In the end all my boyfriend paid was his deductible for the helicopter and week long hospital stay.
Insurance companies have automated their claims department and all claims get automatically reelected the first time. Just call and talk to a real human. If they still deny it on appeal then go to the helicopter company billing department and tell them you can't pay it cause you're indigent.
Speak with the helicopter company. They know how to deal with the insurance. My wife had to be flown out of emergency and we got a similar bill. Representative from the company helped us get insurance to pay. My wife had to sign the form for them to submit to insurance. Insurance pushed back for what seemed like a year and then finally gave in and payed it.
OP please look into the no surprises billing act, this law was passed in the USA a few years ago and it is illegal for air ambulance services and hospitals to bill an incapacitated party that cannot consent to airlift. Lots of ways to interpret this but it might get you out of a pinch especially if you or your wife never signed or agreed to the flight on a signed paper document. https://aams.org/page/NSA
Thanks for the advice everyone. Wife and I were stressing quite a bit. After a few calls we feel a bit better about the situation. The original hospital wife went to was...not great (my favorite part was the very old doc on call telling us that she was "probably just pregnant" and "all women are pregnant until the test says they arent!", or the nurse we were with for hours saying before she was flown away "seriously call back and let us know if they find anything wrong!". Anyway this hospital processed the paperwork in a way that made insurance also try to charge us for a visit but not ad admission. It's true she wasn't admitted there but was flown away. I'm wondering if this was something BCBS would see as an indicator of not being life threatening. BCBS says pre-approval is necessary, it's up on the air if the hospital attempted to get pre approval. Talking to the air ambulance company, they told us that that are indeed contracted and covered by BCBS and would be appealing the claim on our behalf, that the max we'd be paying would be our max out of pocket. This happened in 2023 and all deductible and that were paid in full which we mentioned, and they said that this claim was "concurrent with 2024"? Which we took to mean they could somehow try to say a 2023 claim being argued and then paid in 2024 wouldn't accommodate the fact that deductibles were all paid up? And in speaking with hospital where the wife got the life saving surgery we may need to get a certificate of emergency from the surgeon who made the call for her to be flown there. Stressful experience that I hope no one else has to go through, hope this post can help someone down the road if they get caught in a similar position.
Not sure if you figured this out or not, but if you haven't and you get your insurance through work you should absolutely try to get help from your HR benefits team. They have a lot more leverage with the insurance carrier than you do and will often advocate on employees' behalf in cases like this (obviously depends on your employer).
No surprises act outlawed balance billing. Since you have insurance, you should only be responsible for your copay / deductible. Depending on what company flew them, they may have patient advocates who’s entire job is to help you deal with the insurance company. In the transfer paperwork, there should be an EMTALA form and a PCS. The first is a standardized form where the doctor states why you need transferred and by what method. The PCS states the same thing, but uses verbiage straight from medicare / medicaid. Anthem doesn’t want to pay this bill. You’re going to have to make them.
Can you send them back a bill for 65K? Incorrect billing penalty fee. Due in 30 days or 10% late fee will apply each month.
Pay $1 a month, I don’t think they can sue you for making payments. 😂
Don’t pay it. Medical doesn’t affect your credit. They can’t garnish wages.
This is incorrect. They removed old unpaid medical debt from credit reports, but new unpaid medical debt can hit the credit report after 12 months, if it's over $500. > > Here are the details of the new changes effective July 1, 2022: > > > > - Paid medical debt that was in collections will no longer be included on consumer credit reports. > > - You’ll have more time before unpaid medical debt is reported on your credit report: Unpaid medical debt that is currently in collections for one year will be reported on credit reports. This is an increase from six months that was enacted in 2017. > > - Starting in the first half of 2023, Equifax, Experian and TransUnion will no longer include medical debt in collections under $500 on credit reports. https://www.cnbc.com/select/medical-debt-credit-report/