Paul Vinci was on the brink of death when doctors at St. Luke's Meridian Medical Center called for an air ambulance. They needed to get him to a hospital in Salt Lake City, because his body was about to shut down.
Now, whether Vinci must pay the $56,804 bill for that air ambulance ride hinges on a case in federal court.
Vinci works in health care. He understands the system. He could walk blindfolded through the labyrinth of insurance. But he still was baffled by what happened after Life Flight filed a claim for his transport to Utah.
Vinci was sick with acute necrotizing pancreatitis. On a Friday in June 2017, while accompanying his wife to a car dealership, he passed out and vomited in the parking lot. He had abdominal pain.
An ambulance arrived and took him to the St. Luke's Meridian ER. The doctors found that Vinci's body was having a dangerous inflammatory reaction to something, and his pancreas was in worsening shape.
Vinci already had lived through sepsis and fungemia, a fungal infection of the blood. The doctors worried he was going downhill fast, again.
They consulted with University of Utah hospital physicians who had treated Vinci and recently had done a surgery on him. If he went to Utah in an air ambulance, he could be there in 90 minutes. If he went by ground, it would be five to six hours.
"When you're laying in bed with a life-threatening illness, and your doctor says it's an emergency," Vinci told the Statesman, "it's hard to go against medical advice and say, 'I'll have my wife drive me there.' "
The medical staff made sure he was stable enough to make the trip and sent him off on a Life Flight airplane. Vinci had been in and out of the hospital for three months. Now he was headed back again.
When he finally returned home for good, Vinci started going through the stack of bills and paperwork that had accumulated. He learned that Regence BlueShield of Idaho denied coverage for the flight, saying that because he was stable when Life Flight loaded him up, it wasn't a matter of life and death.
Vinci said Life Flight told him they tried to appeal the denial twice and lost. The bill was on him.
Vinci tried to appeal on his own. He says Regence wouldn't even consider it, because he'd missed the appeal window.
Eventually, he hired Boise lawyer Chip Giles.
"I deal with a lot of people who are injured, and they're going through what Paul is going through," Giles told the Statesman. "I rarely meet someone who is as up to speed as Paul is."
If it's that hard for Vinci to get medical care covered, "there's no hope for the rest of the people out there," Giles said.
And it wasn't just the Life Flight claim. Because he was in the hospital for so long, several of Vinci's bills were sent to collections before he knew about them.
"Personally, I had to negotiate—one was even the attorney general of Utah," representing the university medical center, Vinci said. "I got to thinking, how terrible is this that I'm supposed to be recuperating from a life-threatening condition, and I'm having to fight with the attorney general over $300?"
What about the Life Flight bill? Why was it so huge?
Regence BlueShield of Idaho declined to comment for this story, citing pending litigation.
In court documents, Regence either denied or said it didn't have enough information to respond to each of Vinci's allegations, except to say that he was in stable condition when he got in the Life Flight airplane.
Michael Weimer, the Boise-based regional director for Life Flight Network, said he could not comment on Vinci's case because of patient privacy rules. The Statesman asked if he would be willing to talk after Vinci signed a privacy release, but Weimer did not respond.
The air ambulance trip was actually Vinci's fourth that year. The other three trips had been covered, including one with Life Flight. (Two were with the University of Utah's air ambulance service, he said.)
Life Flight is a nonprofit business, and it does write off some of its bills as charity care. But its business model is to sell memberships—$65 a year for locals—that cover the trip if a person ever needs it.
The local Life Flight website says the cost of a trip starts at $19,993.
"The fees directly reflect the quality of our program through our investment in safety; the training and expertise of its mechanics, pilots, intensive care nurses, paramedics, respiratory therapists and EMTs; the aircraft and ground units employed, and the sophistication of the medical equipment and supplies on its aircraft and ground units," the website says.
It's also expensive to carry blood on board for transfusions, it says.
"When we transport a patient under medically necessary and emergent conditions we have no idea if we'll be paid at all," the company goes on to say. "Healthcare in general is expensive. Add in the cost of aviation services and you have two service lines that are the most regulated, most expensive in our country."
The costs of air ambulance rides have made headlines for years.
One story by NPR in 2016 highlighted a case of a Montana girl whose family sent her via air ambulance to Seattle for life-saving medical care as an infant. But the ambulance wasn't in network—it didn't have a contract to take their insurance. (Vinci's wasn't, either.) Their bill was also about $56,000.
Balance billing, which is legal in Idaho, is when a health care provider isn't in network with an insurance company, and they bill the patient for whatever the insurer doesn't cover.
That wasn't the issue in Vinci's case, but it's caused problems for other Idahoans. The Idaho Department of Insurance received two complaints and one phone call in 2017 about balance billing by an air ambulance provider.
Dean Cameron, director of the department, said balance billing usually comes from out-of-state air ambulance providers. The Idaho companies have worked with hospitals to try and prevent surprise bills, he said.
"[As] a former member of Life Flight, and one whose daughter was a beneficiary of their tremendous service, I know and appreciate their service," he said. "However, it would be better for all consumers to have air ambulance companies contract with hospitals and insurance companies. And hold the consumer harmless."
Vinci is mostly recovered now. As long as he takes medication, he does OK, he said.
The bills from his illness are approaching $750,000, he said. The Life Flight bill has become just a piece of that. He's dealt with a parade of creditors—more than 40 of them, he estimates.
"It's really a convoluted path to get ill in this country," Vinci said. "Sometimes it makes you wish you would've not woken up from that."