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Sky-high bill for life-saving flight

Owen Beasley was born with a jaw so small that if he laid on his back, his airway would become obstructed and he wouldn’t be able to breathe.

He required emergency surgery, but no Medford hospital could provide it.

“It was an extremely scary moment,” says his mother, Gretchen Beasley of Medford. “We were just told he needed this surgery and a helicopter was coming to pick us up. We did what we had to and had no time to think, but thankfully I was able to be with him the entire time.”

Owen was flown on a Life Flight Network air ambulance plane from Asante Rogue Regional Medical Center to Oregon Health & Science University’s Doernbecher Children’s Hospital Neonatal Intensive Care Unit in Portland, where he received his surgery and stayed for a month until he was cleared to go home.

Turning 2 years old in September, Owen is now a lively and healthy child. But the happy ending came with a high cost: The bill for Owen’s Life Flight ride totaled $52,304.

“After needing this transport and life-saving surgery, you think you’ve made it through all you can handle, and then you have this huge bill after everything,” Gretchen says. “You feel like you’ve been through the hardest thing you’ve ever been through, and then this.”

Air ambulance costs surge

The cost of air ambulance services has skyrocketed in the last decade, according to a July 2017 Government Accountability Office report that focuses solely on helicopter transport but provides a snapshot of a growing trend.

The report finds that the median cost of air ambulance services nationwide doubled between 2010 and 2014, to about $30,000 per transport. A complete analysis of what factors are driving those costs wasn’t possible because of a lack of available data, the report says.

Examining Air Methods, an air ambulance company that serves 48 states, the report says that the average price per transport surged from $13,000 in 2007 to $49,800 in 2016 — a 283 percent increase.

“Helicopter air ambulances reduce transport times for critically ill patients during life-threatening emergencies,” the report says. “Although patients typically have little to no choice over the service or provider given the often emergency nature of the transports, they might be billed for charges that have potentially devastating financial impacts.”

Babies in crisis often flown to OHSU

Owen’s surgery required a team of specialists at OHSU’s neonatal unit, classified as Level IV. Rogue Regional’s NICU, where he was born, is a Level IIIB. He was flown to Doernbecher by OHSU’s PANDA (Pediatric and Neonatal Doernbecher Ambulance) team.

Rogue Regional can provide comprehensive care to infants, including advanced respiratory care and imaging services, but it cannot do major surgeries or advanced specialty services, says Asante NICU clinical manager Michelle Cathcart.

“What happens is other hospitals have a full complement of teams, where a baby may see a pediatric surgeon, different doctors and a full team of specialists who are there,” she says. “It’s normal that NICUs vary, and that transports happen to those hospitals with more capabilities.”

Cathcart says hospitals in Eugene and Redding also operate Level III NICUs, leaving hundreds of miles in Southern Oregon without a NICU that provides an absolute range of care. Cathcart says 18 NICU patients at Rogue Regional were transported to a higher-level hospital in 2017.

A licensed practical nurse herself, Gretchen formerly worked at Rogue Regional and says the need for emergency transport to higher-level hospitals appears “common” in the area.

“In our rural area, people have to get flown a lot,” she says. “The hospital doesn’t do a lot of pediatric care, so any kids or babies getting flown to OHSU are left with these huge bills.”

On average, the PANDA team transports more than 800 patients annually from throughout Oregon and Washington, an OHSU spokesperson says in an email.

There was additional ground-ambulance transportation once the Beasleys landed in Portland, but the air-travel time was less than two hours, Gretchen says. When the bill for the flight arrived, she says she was shocked.

“Over $52,000 for a two-hour ride,” she says. “Can you imagine?”

Life Flight contracts with OHSU

Life Flight Network LLC contracts with OHSU, one of Life Flight’s owners, to provide emergency transport for seriously ill or injured patients, often from another, lower-level hospital. Life Flight is a limited liability company, which allows it to make a profit, though at one point on its website it claims it’s a nonprofit.

“We acknowledge it is a bit complicated,” says Jay Hull, an attorney for Life Flight Network, in an email. “Life Flight Network LLC is an Oregon limited liability company, which operates as a not-for-profit air medical transport service.”

Hull says Life Flight Network can be considered a not-for-profit because of the nature of its ownership, structure and operations. The owners are nonprofit hospital systems Legacy Emanuel Medical Center, Providence Health & Services and Saint Alphonsus Regional Medical Center and OHSU, a public corporation.

Hull says that while not a 501(c)(3) nonprofit, Life Flight Network “conducts its affairs for the benefit of the communities it serves.” He says there are no private shareholders or owners in Life Flight Network, and the company “is organized to promote health and otherwise benefit the community.”

The company has helicopter, plane and ground ambulance bases in Oregon, Washington, Idaho and Montana. According to Regional Director Jacob Dalstra, Life Flight transports approximately 15,000 patients annually.

Insurance covered only two-thirds

Both Gretchen and her husband, Jesse, are medical professionals. Together, the two make “a fairly good living, and have great insurance,” Gretchen says. The couple’s insurance covered $39,228 of their Life Flight bill, leaving them accountable for $13,076.

“There’s an irony to all of this, and it’s that my husband and I both work in health care and I had seen this happen to a lot of families before,” she says. “I can’t imagine that people get the same expensive bills, but even less might be covered by insurance.”

Gretchen says that the cost of Owen’s monthlong stay at OHSU — which included surgery, medications and around-the-clock care by numerous medical professionals — totaled roughly $2,500 after coverage from insurance.

“There’s a disconnect there,” she says. “If a patient is going to owe $13,000 for a two-hour ride, after insurance has covered tens of thousands of dollars of the whole bill, something is so flawed.”

Air ambulance services are staffed with specialized teams who can provide emergency care while transporting patients in crisis. But Owen received “no medical care on the flight, just a little bit of sugar water,” his mother says.

Gretchen says she didn’t sign any paperwork with Life Flight before, during or after the transportation. She says the only thing she signed was a consent form to transfer care from Rogue Regional to OHSU, which did not include an agreement with Life Flight.

“I didn’t ever sign paperwork saying that I’d pay for the trip, I was just told we were getting picked up and there we went,” she says. “For my baby’s life I would’ve paid anything, but in this case, I didn’t agree to do so.”

Life Flight Network’s website contains a Patient Consent to Transport form, which states, “I agree to pay Provider’s charges for the Services, including but not limited to any copayments, deductibles or other expenses not covered by insurance.” An estimated cost of transport is not listed.

When Gretchen reached out to Life Flight to ask for copies of all paperwork she signed, Life Flight confirmed she did not sign its consent form but told her via email, “The OHSU consent form that was signed by you authorizing transport and treatment indicates agreement with the hospital and sending physician that transport by air was necessary and authorized transport. That is sufficient to bill a claim to insurance or the responsible party.”

Regarding the cost of transport from the standpoint of medical professionals at Rogue Regional, Cathcart says they focus only on the health of a patient.

“As far as cost goes, that is not something that we have a conversation with anybody about,” she says. “We’re just acting on, ‘This baby is sick, and it needs to get somewhere where it can get the care it needs.’”

Why life flights cost so much

Dalstra says a Life Flight transport starts at about $20,000 and can cost up to $100,000 or more for international transports.

The fees charged by Life Flight Network for air transport “reflect our investment in safety, quality, the training and expertise of our mechanics, pilots, critical care nurses, paramedics, respiratory therapists and EMTs, the aircraft and ground units employed, and the sophistication of the medical equipment and supplies on our aircraft and ground units,” Dalstra says in an email. “The clinical standards for our medical crew are the highest in the state.”

For Owen’s ride, Gretchen’s bill shows that the “Fixed Wing Base Rate” totaled $18,134. The bill states that the transport was 201 miles, and “Fixed Wing Mileage” totaled $34,170 — coming out to $170 per mile.

When asked whether the cost of a transport ever poses challenges or hardships for families, the OHSU spokesperson says in an email, “Unanticipated medical events can cause emotional, physical or financial stress. In the case of emergency trauma care or medical transport, feelings of anxiety or hardship may be elevated, especially when a loved one is affected.”

Blair Beggan, vice president of communications for the Association of Air Medical Services, a nonprofit that represents air medical and critical care ground transport providers, says keeping highly trained professionals and specialized aviation equipment on call is expensive. While individual flight costs can vary, “it costs about $3 million per year to operate an air medical base,” Beggan says.

Those costs include aircraft and maintenance, medical and safety equipment and maintaining licensed, highly trained flight and medical teams that are prepared to respond 24 hours a day, 365 days a year.

“An air medical flight can be expensive, but it can be a lifesaving medical intervention that can often mean the difference between life and death,” she says.

Nonprofit’s costs are lower

Locally, nonprofit air ambulance service Mercy Flights is the oldest private, nonprofit air ambulance service in the U.S. The company was founded in 1949.

Mercy Flights provides fixed-wing air ambulance services within 1,000 miles of Medford in the western U.S.; helicopter ambulance services within 150 miles of Medford in Southern Oregon and Northern California; and ground ambulance services within a designated Jackson County service area.

CEO Doug Stewart says Mercy Flights conducts more than 400 fixed-wing transports and more than 200 helicopter transports annually.

He says that currently, there are no state or federal regulations on how much air medical transport companies can charge.

Air Methods, for example, is owned by a private equity firm.

“I’m sure there’s pressure on these other companies to answer to investors and be making a profit, so they charge these extreme amounts,” he says. “Luckily, we don’t have to operate with that pressure.”

According to Stewart, the base rate for a fixed-wing transport with Mercy Flights is $12,925, and the mileage fee is $70 per mile. If Owen’s 201-mile journey from Rogue Regional to OHSU had been with Mercy Flights, the bill would’ve totaled $26,995.

“Air medical transport is expensive regardless of the company, but these other companies charge way too much, there’s no doubt about it,” Stewart says.

According to Asante spokeswoman Lauren Van Sickle, when a transport is necessary at Rogue Regional, the hospital receiving the patient makes the arrangements.

Had the Beasleys been members with Mercy Flights, could they have chosen to be transported by the Medford nonprofit instead?

“While a family could consider other transport options, to OHSU’s knowledge, Mercy Flights does not offer pediatric or neonatal specialty care or equipment, which is required for best care outcomes in most emergency transport situations,” says OHSU spokeswoman Tracy Brawley.

But Mercy Flights Chief Operations Officer Tim James says Mercy Flights does offer pediatric and neonatal specialty care and equipment. He says Mercy Flights partners with NICU medical staff at Rogue Regional when transporting a baby, and that it is “extremely rare” that there is a patient it cannot transport.

Membership can keep emergency flights affordable

To minimize charges that a family might owe after an emergency transport, both Mercy Flights and Life Flight offer a variety of membership packages.

Mercy Flights’ annual membership fee for a family is $85. Stewart says more than 17,000 households have memberships.

For members, insurance payments for a transport are considered payment in full. If members don’t have insurance or the insurance denies payment, the bill is reduced by 50 percent.

“What we don’t want is to run into someone at the store and hear that they needed our services before they were members with us,” Stewart says. “We want to be present in this community, and memberships help people in that time of need and help us maintain operations.”

A $65 annual membership with Life Flight Network will cover the entirety of a family’s air transport bill that isn’t covered by insurance. According to Dalstra, approximately 150,000 households have memberships with Life Flight Network.

Even so, Gretchen says, members wouldn’t be covered outside the company’s service area.

“You never know where you’re going to be, so whatever flight company is nearby, you’re on the hook for however much they want to charge you,” she says. “It’s just depending on where you are and if you happen to have a membership with that particular company that you might or might not have to pay.”

Life Flight Network has a financial assistance program for clients unable to pay. Gretchen says she has not completed the financial assistance form because she “didn’t agree to pay anything.”

According to Life Flight’s website, members may be covered if transported by one of the organization’s reciprocal partners, which include Air St. Luke’s, Airlift Northwest, Care Flight, Enloe FlightCare and Air Idaho Rescue.

Dalstra says Life Flight Network has “reached out multiple times to Mercy Flights over the years requesting to have reciprocity between our membership programs,” but that Mercy Flights has declined.

James says Mercy Flights doesn’t have reciprocal agreements with any other flight programs because “in the flight industry, there are questionable legalities around that.”

“Our business models (nonprofit vs LLC) are very different, so that lends to questions about how we would do that successfully,” he says. “There are a lot of questions within the flight industry as to whether that’s even legal.”

Solutions will take national efforts

Beggan says the Centers for Medicare and Medicaid Services hasn’t reviewed what it pays for air medical transport in nearly 20 years, and commercial insurers are “putting added strain on the system” by failing to cover emergency air medical costs.

According to the GAO report, the median payment from Medicare was $6,502 per transport in 2014.

Beggan says the Association of Air Medical Services believes the solution to the high cost of air travel requires a dual approach.

First, private insurers can “negotiate fair and reasonable in-network agreements with air medical providers in their service area,” she says.

“Air medical companies would absolutely rather operate in-network to provide operational stability, to better predict their operating budget, and to avoid the administrative burden of onerous claims processing,” she says. “If your insurer doesn’t pay your medical bills in an emergency medical situation, what is insurance for?”

Second, there’s a bipartisan bill before Congress that would address the “Medicare reimbursement shortfall,” Beggan says. Called the Ensuring Access to Air Ambulance Services Act, the bill would “establish a mandatory quality reporting program and improve transparency of costs among providers, patients, and insurers.”

Gretchen says she is working to find a lawyer to attempt to dispute the charges of the Life Flight service. She says her family now has a membership with Mercy Flights, and should the Beasleys ever need emergency transportation again, “we’ll be prepared.”

“In an emergency, no one is thinking that just getting to the hospital is going to be so costly and end up being such a hard part of the battle,” Stewart says. “And no one should ever have to.”

Reach Mail Tribune reporting intern Morgan Theophil at mtheophil@rosebudmedia.com or 541-776-4485. Follow her on Twitter @morgan_theophil.

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