Mo. Patients Up in Arms Over Air Ambulance Bills

Apr. 23—Dan Millheim, meet Dee Goodin.

And while you're at it, say hello to John and Jennifer Allen, Tom Seeger and at least 10 other Missourians who are facing hefty bills for air-ambulance service.

After the Post-Dispatch last month reported how Millheim was stuck with a $32,000 bill from the transport of his gravely injured son to a hospital, the newspaper heard from other people in similar straits.

As in the Millheim case, insurers covered just a fraction of total transport costs because the air ambulances were deemed "out-of-network."

Millheim's son, Ben, fell in 2016 during a camping trip in rural Missouri and fractured his skull. Because the boy was unconscious, bleeding from his ears and having seizures, he was taken by Air Evac Lifeteam to a St. Louis hospital. The Millheims' insurer, Anthem Blue Cross Blue Shield, paid $11,787 of the $44,232 bill, leaving the family with a balance of $32,445.

The insurer denied the rest of the Millheim claim, even though a medical professional made the decision to call an air ambulance. Others who now face massive bills tell a similar story—and are now asking why there are no safeguards to reduce the financial blow.

Dee Goodin, 31, says he's "lost all hope" of getting Air Evac to forgive the $36,000 the company says he still owes.

Goodin, who operates a lodge and camping resort along the Black River, flipped his Jeep in Reynolds County late last year, fracturing multiple vertebrae in his back. He was airlifted to Mercy Hospital in Creve Coeur.

Air Evac billed Goodin's insurer, Anthem Blue Cross Blue Shield, $47,560. The insurer paid nearly $12,000, leaving Goodin on the hook for the remainder of the bill, which totals $35,672, according to documents Goodin provided to the Post-Dispatch.

Air Evac is considered out-of-network, which means Anthem and Air Evac have not agreed to pricing terms, leaving patients like Goodin stuck in the middle.

"I'm going to be honest, I am not entertaining their calls. I'm not interested in taking on a bunch of debt," he said, noting it's almost as much as the remainder of his mortgage. "I just feel like it's a failure of the industry and, ultimately, it's leaving the insured to hang in the wind."

Jennifer and John Allen of Warrenton owe about $51,000 after John was airlifted from a Cape Girardeau hospital to SSM Health St. Joseph Hospital-Lake Saint Louis.

Anthem denied the payment entirely.

While on a trip in Poplar Bluff, John Allen, 47, couldn't breathe—he has chronic obstructive pulmonary disease and emphysema and went into cardiac arrest. He was taken to a hospital in Cape Girardeau, then transported by air ambulance to the St. Charles County hospital, where his specialists are located. Anthem refused to pay because the air ambulance flew by a hospital that was closer to their original location.

"In these cases you should be taken to the closest hospital that is able to give you the care you need to reduce your risk. We do not see that you were taken to the nearest appropriate hospital. For this reason we believe that air ambulance transport was not medically necessary for you," according to a denial letter that was sent to the Allens.

Jennifer Allen, 36, is an assistant office manager and her husband is a mechanic. They are currently working their way through the appeals process with Anthem. They are willing to set up a payment plan, but are hoping Anthem will pay a portion.

Tom Seeger owes slightly more than $27,000 after breaking three ribs and bruising his lung after a 14-foot fall while attempting to fix a zipline on his rural property.

He made it to a nearby hospital; it had him airlifted to Mercy in Creve Coeur.

Anthem paid part of the bill but left him owing about $22,000, which was turned over to a collection agency in 2016. The debt has since accumulated interest and Seeger now owes slightly more than $27,000, according to documents he provided to the Post-Dispatch.

"I've refused to pay them and I told them to sue me," said Seeger, owner of Seeger Toyota. "I think there's a racket going on."

Similar stories about patients stuck with high air-ambulance bills have been relayed to the Missouri attorney general's office.

The attorney general's office has logged and investigated 10 consumer complaints from consumers since 2016, according to a records request submitted by the Post-Dispatch. The attorney general's office did not have a comment about overall findings, which include allegations against multiple air ambulances including Arch Air Medical Services, Air Evac Lifeteam and Survival Flight.

In one instance, a parent, whose identification has been withheld by the attorney general's office, said that after their child was born prematurely he was airlifted by Arch Air to a hospital that could care for him.

"This company is taking massive financial advantage of Missourians at their most critical time of need; by refusing to partner with insurance companies and sticking families with untenable bills," according to one complaint on file.

A different parent in a similar situation also filed a complaint about Arch Air, alleging the company sent a nearly $43,000 bill to collections.

In this case, a newborn was experiencing stomach issues, which needed the attention of specialists in St. Louis.

After the insurance paid more than $12,000, the family was left with a nearly $43,000 bill.

"We have been turned over to a collection agency for the remaining $42,505," the complaint states. "We tried to arrange payments with Arch Air but they were unaffordable, wanting $300 to $400 a month."

Because of the way private health insurance operates, there's no marketplace solution to the problem of excess billing if air-ambulance companies are unwilling or unable to negotiate rates with insurers and insurers refuse to pay for out-of-network services.

That points to a need for legislation, say some health care policy experts.

"Without regulatory limits, there may be nothing to stop air ambulance providers from price gouging and balance billing in this way," said Erin Fuse Brown, associate professor of law at Georgia State University.

The Post-Dispatch story about the Millheims prompted state Sen. Jill Schupp, D-Creve Coeur, to send letters to various state departments and meet with representatives of the Missouri Department of Insurance to discuss her concerns.

Schupp also is working to pass legislation aimed at protecting consumers from surprise bills after emergencies; however, due to the way air ambulances are regulated, changes to state law would likely prove ineffective in protecting consumers from these types of air ambulance bills.

"People don't stop and say to each doctor that sees them (in an emergency), 'Oh, by the way, are you an in-network doctor?'" she said.

Schupp said her legislation would attempt to protect patients from balance billing, which is when patients are billed for the difference between what an out-of-network provider charges and what the insurance company actually pays.

In some cases, patients can go to an in-network hospital but be treated by a doctor that's out-of-network, exposing them to more financial risk. Schupp's bill would apply only in emergency situations.

"The bill puts together a framework for making sure that the provider and the insurance know how to work out the payment and the patient is excluded," Schupp said.

However, because air ambulance services are federally regulated, she said, it's unlikely her bill would protect consumers for balance billing in these situations.

The issue has prompted Dr. Randall Williams, director of Missouri's Department of Health and Senior Services, to call on his colleagues at the Department of Social Services and Department of Insurance to see what role, if any, state agencies can play in assisting families.

He has had at least one meeting with various department heads including Steve Corsi of the Department of Social Services and Chlora Lindley-Myers of the Department of Insurance.

Those representing the insurance industry say the flaw in the system is that there is no incentive for air ambulance companies to join a network.

"This is what happens when an insurance provider is not able to negotiate those lower prices for you. You as a consumer are left to see the entire impact of the out-of-control prices," Kristine Grow, spokeswoman for America's Health Insurance Plans, told the Post-Dispatch.

Critics say failure to reach a pricing deal puts Americans in precarious situations. The median household income was $57,617 in 2016, according to the U.S. Census Bureau.

The industry across the U.S. is dominated by three for-profit air ambulance companies, which control 66 percent of the market, according to a 2017 report from the U.S. Government Accountability Office, citing figures from 2015.

The state's two largest insurance companies—Anthem Blue Cross Blue Shield and UnitedHealth—do not have any in-network air ambulances through direct contracts. However, in some cases hospitals have pricing contracts with the air ambulances, by extension giving UnitedHealth and Anthem pricing deals because of their arrangements with the hospitals.

Faced with similar consumer complaints, North Dakota took steps last year to inform patients about which air ambulance companies are in-network with the state's largest insurance providers. Providers are required to share the information with patients, and the state's insurance commissioner also maintains a consumer-friendly guide that identifies carriers that are part of a network and those that are not.

Consumer advocates in Missouri say patients need to call on legislators to demand action.

"If you have consumers calling you, they need to call their legislators. This is a systemic issue," said Ryan Barker, vice president of health policy with the Missouri Foundation for Health.