A 61-year-old DeWitt man feared he’d die after suffering a heart attack aboard a cruise ship more than 1,000 miles from a Florida port.
Robert Shapiro said once he got to nearby British Virgin Islands, doctors recommended he take an emergency medical flight because they had no cardiologist, its hospital decimated by a 2017 hurricane. Doctors on the 24,000-person island worried he might have a blocked artery, which could cause stroke or worse, Shapiro said.
“At the time, we thought it was life and death,” Shapiro told Syracuse.com | The Post-Standard recently. “I’m going to sign whatever they give me to get going.”
That started with a $36,000 retainer fee to REVA air ambulance, which Shapiro willingly paid with his credit card after calling his insurance company.
Fortunately, it turned out that Shapiro’s heart attack in April 2018 was more scare than a true emergency. But, he says, the bigger pain came later.
Excellus Blue Cross Blue Shield refused to repay Shapiro for any part of the 1,800-mile trip home to Syracuse. Shapiro said an Excellus rep had promised beforehand that the air ambulance bill would be covered.
“We didn’t have anything in writing,” Shapiro acknowledged. “We’re on a cruise, in the middle of an island. No laptop, no email.”
Things got worse when the air ambulance then billed his insurance—which denied coverage—for a whopping $656,063.
“I figured it was a misprint, but it wasn’t,” Shapiro said of the astronomical figure. “You could buy a plane for what they charged.”
The insurance company, which had already balked at paying for Shapiro’s trip, sent him a notice insisting he faced the bill for two-thirds of a million dollars.
“Am I responsible for the whole thing?” Shapiro wondered. “The $36,000 was just a retainer.”
In late May, Shapiro filed a lawsuit against Excellus on two fronts: demanding the insurer repay him $36,000 for his out-of-pocket air ambulance fee and to expunge the $656,063 bill.
“They turned down the entire trip,” he said. “They wouldn’t even pay to get me from the island to Fort Lauderdale (about half of his out-of-pocket costs). They should be ashamed of themselves.”
Air ambulance companies know they have patients over a barrel when doctors or first responders recommend an emergency flight.
There’s a trip insurance industry that promises to pay for such emergencies, on cruise ships and in foreign lands. But Shapiro says his health insurance covered such emergencies—and, he added, the global Blue Cross rep he contacted confirmed that.
Consumer Reports noted the average cost for a U.S. air ambulance topped $50,000 in 2016. For those on Medicare or Medicaid, the government only pays between $200 and $6,000 per transport. That leaves those on private insurance with exorbitant bills to make up the difference, a trade group president told Consumer Reports in 2017.
Flying someone from a distant island is bound to be more expensive than an average domestic flight. And REVA, the air ambulance that flew Shapiro, billed for more than a half-million dollars in a similar fight in 2017.
A Vermont doctor, injured while on vacation in the Dominican Republic, took a REVA Learjet—the same type of plane that transported Shapiro—back home. The upfront payment in that case was $38,135.
REVA then billed the doctor’s employer, the University of Vermont Medical Center, for $536,000, according to a news account. The hospital agreed to pay $218,116, then later regretted it, according to a December 2017 story on VTDigger.com. It’s unclear if REVA ever pursued the remaining bill of $317,884.
Shapiro said he hasn’t been personally billed the $656,063 by REVA. He thinks it’s a ploy by the company to settle with Excellus.
“Basically, as it stands, I believe they bill an outrageous amount, then settle a lesser amount,” he said. “What sticks, sticks.”
But what if the insurance company refuses to pay any of it? REVA could technically go after Shapiro personally. He’d have to fight REVA in court, too.
For now, Excellus hasn’t paid REVA a dime and REVA hasn’t billed Shapiro directly, he said, citing insurance statements.
But Excellus is citing the $656,063 figure in denying any payment at all, he said. If Excellus reimbursed Shapiro—acknowledging he was covered—would that open the door for REVA to demand the full amount from the insurer? Shapiro wondered.
“So Excellus takes it out of me?” he said. “That doesn’t make any sense.”
Excellus defended its denial in a number of appeals filed by Shapiro—all of which sided with the insurer. Their rationale? Shapiro’s emergency ambulance ride wasn’t medically necessary.
Shapiro’s flight took off from the Virgin Islands and stopped to refuel in Fort Lauderdale, about halfway home.
After arriving in Syracuse, a ground ambulance rushed Shapiro to St. Joseph’s Hospital Health Center, where he got good news: there was no artery blockage. He had angina, chest pain caused by reduced blood flow, and a-fib, the medical term for an irregular heartbeat.
Now healthy, Shapiro said he realizes taking the air ambulance wasn’t necessary.
“In hindsight, of course it wasn’t,” Shapiro said. “But if you were there at the time, and all the doctors were saying take it, and you took the extra steps of calling just to make sure this didn’t happen, it’s amazing this did happen.”
The insurance company argued that Shapiro’s air ambulance wasn’t necessary in the first place. As proof they noted that he decided to fly all the way home to Syracuse instead of getting help as soon as he reached U.S. soil.
“...air ambulance transportation services may be determined to be medically necessary to the nearest facility that can provide the appropriate care...” the insurer wrote Shapiro in 2018, a day after Christmas. “You were transported by an air ambulance to a hospital in Syracuse, New York, far from the location of the nearest hospital that could provide the appropriate care. Therefore, our Medical Director determined that your air ambulance ride was not medically necessary.”
The insurer upheld its denial within an internal appeals process, then sent the case to an independent reviewer under a state program. That reviewer—an unnamed medical doctor certified in cardiovascular medicine—agreed the flight wasn’t medically necessary.
The reviewer also faulted Shapiro for flying all the way home to Syracuse, and not getting treatment in Fort Lauderdale. The reviewer suggested that Shapiro’s decision to fly all the way home put him at unnecessary risk.
But the reviewer did rule that an air ambulance off the island was medically warranted.
Shapiro argues that the insurer should, at minimum, pay for his flight to Fort Lauderdale.
“How can you not have paid the first half of it?” he asked. “How can you even turn that down?”
Shapiro said that he has notes proving medical necessity from doctors on the British Virgin Islands, from the air ambulance company and from his own cardiologist at St. Joseph’s Hospital Health Center.
He said the second half of the trip—from Fort Lauderdale to Syracuse—came down to a personal decision he made with his doctor back home.
“If I’m going to be laid up in hospital for a couple months, I wanted to be at home in Syracuse. I wanted to be near my cardiologist,” he said. “It was worth the risk to come home.”
Shapiro, who is president and ownership partner of Central New York’s Tile & Carpet Town, had no complaints about his treatment, from the cruise ship to the island to the air ambulance crew.
He took the two-week trip with his wife, Patricia, aboard Silversea’s Silver Muse cruise ship. But two days before their planned return, on April 12, 2018, Shapiro said he started feeling weak. He could barely walk during a trip to one of the local islands.
Shapiro said he checked himself in to the ship’s doctor that evening. The doctor was concerned and told him to come back the next morning.
By then, Shapiro said he felt even worse. He was suffering from an irregular heartbeat. The doctor immediately put him on a gurney and arranged a short boat ride to the British Virgin Islands. There, Shapiro took another boat to the largest island, Tortola.
The main hospital was still half-closed following Hurricane Maria in September 2017, which had heavily damaged Tortola before decimating Puerto Rico, he said.
“They treated me like gold,” Shapiro said of his care. “But they had limitations: no cardiologist, no catheterization lab.”
He spent a couple days getting his irregular heartbeat under control. But doctors said they couldn’t do the tests needed to make sure there wasn’t something worse. Doctors said he couldn’t fly commercially for at least a week, and said he’d need medical monitoring to fly any sooner.
That’s when Shapiro’s wife, Patricia, said she called Blue Cross Blue Shield Global. A representative, Ian Probst, researched their policy and determined Shapiro was covered for air transportation and all medical needs, according to the lawsuit.
With that belief, Robert Shapiro said he contacted REVA for transport off the island to Syracuse, via Fort Lauderdale.
Shapiro says they were told of no limitations on where he could go for treatment. The air ambulance arrived April 16, four days after his heart attack.
Shapiro said the specialized Learjet owned by REVA sounds impressive, but it was actually quite cramped. His luggage wouldn’t fit and had to be shipped separately.
He and his wife were aboard, along with two medical professionals and one or two pilots, he said.
“It was like a little sardine can," he said. “You couldn’t stand up in it.”
Grateful that his condition wasn’t worse, Shapiro said he expected Excellus to challenge the bill. He shrugged off the initial denial as “what insurance companies do.”
After his appeal was denied, Shapiro said he got his lawyer, Sheldon Kall, involved.
Kall tried to describe his client’s predicament in a September 2018 letter.
“Lying in a bed, in a strange area, not knowing if he would live or die, how was he to know there were limitations on travel?” Kall wrote in his appeal.
When that didn’t work, the lawyer filed a lawsuit May 23 in Onondaga County Supreme Court. The insurer has not yet responded in court, but their explanations were contained in Shapiro’s court filings.
In retrospect, Shapiro said, the air ambulance bill might have an even bigger impact on his life than the heart attack. The $36,000 he paid out of pocket will have a real impact: he’ll have to work longer before retirement if he doesn’t get repaid, he said. It’ll put a crimp in other plans, he said, declining to be more specific.
“It’s a lot of money,” the 61-year-old said.
But he still hopes Excellus will reimburse him the $36,000, so he can get square with the air ambulance company.
“I’m still hoping it’ll get resolved,” he said. “Not to mention the $600,000(-plus) bill hanging over my head.”