I hope you can afford that air ambulance you need to save your life.

[Velocity173]

Was talking to the air ambulance guys out here. Their current helicopter is not known ice capable and due to the IFR routes over the hills to where the real hospitals are being too high apparently this one location missed out on 55 calls over this winter due to weather. Sounds like they're working to get RNAV IFR routes available at lower altitudes, probably far cheaper than new helicopters.

Yeah depends on the area. Missed calls for icing isn’t high in the southeast. Makes for a small number of my WX turn downs. Still, it’s amazing that some of these major helicopter manufacturers haven’t come up with a good FIKI for HAA programs.

 

[Velocity173]

I guess I’ll just have to reserve my medical emergencies to warm climates.
https://www.airmedandrescue.com/features/have-ice-flight

Not to worry, you’ll just rendezvous with James and his PC12 at the nearest IFR airport.

 

[weilke]

How on Earth does someone in bad enough shape to need helicopter medivac in good enough shape to consent to the ride? If there's no consent, how can someone bill them? Yes services were rendered, but they were never requested. That's like someone coming to your house and reproofing it without asking you, and then seeing you a bill for service.

If you are incapacitated, any treatment you receive is rendered under a 'implied consent' doctrine. It is assumed that if you were awake, you would consent to treatment rather than instruct the EMS provider to leave you to die by the roadside. Under that consent you enter into a quasi-contract (however one sided it may be) that allows the provider to bill you for services rendered. All this of course assumes that the provider acts in your interest rather than the financial interest of his employer. In the situations where you have a conflict of interest (e.g. a situation where ground ambulance and HEMS are done by the same racket), you may have a case to dispute the validity of the implied consent.

If you are awake, you are certainly free to refuse EMS services or medical treatment at a hospital. Happens every day that ambulances are turned away with a signed refusal. In most jurisdictions, no transport, no bill. You get to the hospital ER you sign an AMA before you are treated, the hospital won't have a case if they want to get paid.

 

[Mike Smith]

I have one option, these guys...

https://www.pilotsofamerica.com/community/threads/final-ntsb-mediva-from-2016.111623/

They are also the ground transport so they would be the ones calling the helo. I looked at their memberships, 95 per year per household, not bad till you read the terms of service. They can basically not “cover” the flight for most any reason and you still have to pay. I have personally had two events involving medivac, one, a guy on a bike ran into the back of my truck, I called 911 and when I said bike, the dispatcher said she was calling the helo. When ems got there they looked at each other like “WTF” and called the helo off. The second one took my sister from the local hospital to the state of the art hospital after she had an aneurysm, they saved her life and I would pay 300k for that fight if I needed to. The bottom line for me is,the need is there, but the system is broken. I think there is enough blame to go around for everyone.

 

[Clip4]

I just checked my health insurance, air ambulance is covered if it is a medical necessity.
It is also covered by Medicare Part B if it is a necessity.

 

[weilke]

I just checked my health insurance, air ambulance is covered if it is a medical necessity.
It is also covered by Medicare Part B if it is a necessity.

Even if your insurance covers it, unless the medevac company is in-network, you may still be on the hook for the 30-50k not covered by the insurers payment.

With part B it's different. The feds are able to just mandate that anyone (contracted or not) accepts their allowable (+5%) as payment in full. It makes negotiating so much easier if you can put your counterpart in jail if they don't comply.

 

[weilke]

I have personally had two events involving medivac, one, a guy on a bike ran into the back of my truck, I called 911 and when I said bike, the dispatcher said she was calling the helo. When ems got there they looked at each other like “WTF” and called the helo off.

Based on the information in the call, certain resources are dispatched by the 911 center (based on a 'run card' or 'box assignment'). For example a 'fire, commercial building' will get a much larger response than a 'fire, single family dwelling', even if the 'commercial building' is a hot-dog stand. Same with a motorcycle accident, it is assumed to have led to serious injury until proven otherwise. In our county, they are dispatched as 'advanced life support' (ALS) call when a car accident gets a BLS unit.

 

[Mike Smith]

Sure, I get that. However, even though this guy could have walked to the hospital, I’m betting if the bird had not been called off, he would have gotten a 35k ride.

 

[Clip4]

Even if your insurance covers it, unless the medevac company is in-network, you may still be on the hook for the 30-50k not covered by the insurers payment.

With part B it's different. The feds are able to just mandate that anyone (contracted or not) accepts their allowable (+5%) as payment in full. It makes negotiating so much easier if you can put your counterpart in jail if they don't comply.

If I have really low quality health insurance, you could be correct, which I don’t. Even out of network, I have a max out of pocket.

 

[denverpilot]

The issue is the opacity of the costs and pricing in the medical industry. I can't think of any other business where the price is not disclosed before service is rendered, or where the people in the business can deliver services based on their "orders" without the full knowledge of the customer as to what the cost to them will be.

The entire government. They also have no competition. Well, yet anyway. Coups are kinda messy.

 

[weilke]

If I have really low quality health insurance, you could be correct, which I don’t. Even out of network, I have a max out of pocket.

Your 'out of pocket maximum' only governs the relationship between you and your insurance company. They will count whatever THEY decided your cost share is against the OOP maximum, they simply have no control over what an out of network (non-par/OON) provider collects from you in excess of that. The only way they could ensure that you don't run over your out of pocket is by just paying whatever the provider bills. I have seen that twice in ten years. One was the government of Kuwait, the other one was some pre-obamacare plan offered to executives at the World Bank. I hear that some plans in New Jersey still pay '80% of charges' (rather than '80% of U&C) for emergency care, as a result NJ is also the home of the $56,000 ultrasound study.

 

[RJM62]

Your 'out of pocket maximum' only governs the relationship between you and your insurance company. They will count whatever THEY decided your cost share is against the OOP maximum, they simply have no control over what an out of network (non-par/OON) provider collects from you in excess of that.

To my knowledge, the service that usually covers my area (LifeNet, which is part of Air Methods) isn't part of any insurance network. They also don't seem to offer any "memberships" in New York, which I suspect has something to do with New York law. When something doesn't seem to make any sense, my experience has been that government is usually involved in some way. But I can't say for sure because neither the company nor the State have ever responded to any of my emails or phone calls inquiring about it.

I probably should ask the County Sheriff. They would either know or be able to find out whether the County has some sort of arrangement with them. If nothing else, at least they'd answer the phone.

Rich

 

[NoHeat]

The issue is the opacity of the costs and pricing in the medical industry. I can't think of any other business where the price is not disclosed before service is rendered, or where the people in the business can deliver services based on their "orders" without the full knowledge of the customer as to what the cost to them will be.

Indeed.

One of the rare times I've seen a clear transparent price before a medical expense was when I arranged for lasik eye surgery, which is not covered by any insurance. The doctor and everyone else made it very clear exactly how much the procedure would cost, and I signed some kind of agreement accepting that price beforehand. It was perfectly reasonable -- and it was the incentive for the caregiver to get paid that made it so.

That example demonstrates that transparent pricing is possible. But alas, an incentive to make it common is lacking.

 

[James331]

Indeed.

One of the rare times I've seen a clear transparent price before a medical expense was when I arranged for lasik eye surgery, which is not covered by any insurance. The doctor and everyone else made it very clear exactly how much the procedure would cost, and I signed some kind of agreement accepting that price beforehand. It was perfectly reasonable -- and it was the incentive for the caregiver to get paid that made it so.

That example demonstrates that transparent pricing is possible. But alas, an incentive to make it common is lacking.

Exactly, and look how the prices have dropped and tech as gone up.

Welcome to real capitalism without too much government interference.

 

[EdFred]

If you are incapacitated, any treatment you receive is rendered under a 'implied consent' doctrine. It is assumed that if you were awake, you would consent to treatment rather than instruct the EMS provider to leave you to die by the roadside. Under that consent you enter into a quasi-contract (however one sided it may be) that allows the provider to bill you for services rendered. All this of course assumes that the provider acts in your interest rather than the financial interest of his employer. In the situations where you have a conflict of interest (e.g. a situation where ground ambulance and HEMS are done by the same racket), you may have a case to dispute the validity of the implied consent.

If you are awake, you are certainly free to refuse EMS services or medical treatment at a hospital. Happens every day that ambulances are turned away with a signed refusal. In most jurisdictions, no transport, no bill. You get to the hospital ER you sign an AMA before you are treated, the hospital won't have a case if they want to get paid.

And what if my estate planning documents say otherwise? Granted the first responders don't have access to those, but it is documented what I do and don't approve of.

 

[Matthew]

And what if my estate planning documents say otherwise? Granted the first responders don't have access to those, but it is documented what I do and don't approve of.

Can a First Alert bracelet say "No air transport"?

edit:

There is a company (there might be others, but this is one I know about):

https://www.docubank.com

They keeps copies of your medical directives, powers of attorney, next of kin, whatever. The ER can call and get it all faxed over. Keep their card next to your medical insurance card since that is definitely something they will be looking for.

 

[James331]

Can a First Alert bracelet say "No air transport"?

You can say all sorts of stupid things on jewelry.

 

[Matthew]

You can say all sorts of stupid things on jewelry.

Does anyone actually look at those?

 

[James331]

Does anyone actually look at those?

As far as allergies and sruff, sure.

But be careful what you try to ask for, just like how people nearly always regret jumping off bridges the second after they do, you're going to be kicking yourself if you see that chopper lift without you as you start coughing up blood because you were trying to save some money.

 

[weilke]

And what if my estate planning documents say otherwise? Granted the first responders don't have access to those, but it is documented what I do and don't approve of.

You need to have some kind of personal representative who speaks on your behalf and communicates the content of your advance directive ('living will', 'personal directive', 'advance decision' pick a name) to the providers. Happens every day. Patient is brought to the hospital with something like a stroke. Kid shows up later that day with a properly executed advance directive. Hospital lawyer looks at it and if it is found to be legit, care is altered/withdrawn based on the instructions provided. Just having the executed document in your safe or at your lawyers office won't do a thing, unless you have someone who can speak on your behalf, it wont do you much good.

Its a bit more complicated if you are not in a hospital. A DNR order is only valid while within the hospital nursing home the patient is located in. A patient located outside of a licensed healthcare facility (e.g. in assisted living) is not covered by such an order. Some states have something called a 'community DNR' which is binding on an EMS provider if he is made aware of its existence.

At the side of the road after a car wreck, there is really no mechanism that could stop the medical industrial complex from doing its thing. Unless you are knocked out and your spouse is there to refuse care on your behalf, there is really no way of enforcing the content of any advance directives.

 

[Dr. O]

I did hard time as a coroner as punishment for evil on a previous lifetime so I was regularly at crash scenes officially pronouncing the dead as the survivors were being triaged and transported. A lady was put in an ambulance and it moved all of 20 feet then it sat there running (bitterly cold night so being in a warm vehicle was indicated) After roughly ten minutes I was finished with my work and inquired as to why the delay in transport given the hospital was ten to twelve minutes away with lights and siren. They indicated they were waiting on the air ambulance on the orders of dispatch. (This is Southern Michigan not Alaska) After I got over the shock I threw a tantrum a three year old would have been proud of. The ambulance lit up and drove away. It was another ten minutes before the helo arrived. needless to say i was not their favorite person in the world after that. Unfortunately that crew (3) died doing a completely unnecessary show and tell at a public event where they lost control and crashed on takeoff. They were good folks. A real shame.

 

[weilke]

Indeed.

One of the rare times I've seen a clear transparent price before a medical expense was when I arranged for lasik eye surgery, which is not covered by any insurance. The doctor and everyone else made it very clear exactly how much the procedure would cost, and I signed some kind of agreement accepting that price beforehand. It was perfectly reasonable -- and it was the incentive for the caregiver to get paid that made it so.

That example demonstrates that transparent pricing is possible. But alas, an incentive to make it common is lacking.

You can find transparent pricing because the government doesn't pay for Lasik. You can also find transparent pricing for botox and purely cosmetic boob-jobs.

 

[Zeldman]

Can a First Alert bracelet say "No air transport"?

Does anyone actually look at those?

Yes and yes.

I know a few people that have "No helicopter transport" bracelets, including myself. However I don't wear it 80% of the time.

 

[Lachlan]

Side note, if a homeless person got hit by a car or something and EMS calls for a medevac, we still respond with the same force and speed as if it were a 1%er liberal in a Tesla, same deal in the ER, they will stabilize/save you just the same regardless of if you can pay, it's even posted in every ER I've been in, and that's quite a few.

That's because of EMTALA. It's the law.

 

[kyleb]

The issue is the opacity of the costs and pricing in the medical industry. I can't think of any other business where the price is not disclosed before service is rendered, or where the people in the business can deliver services based on their "orders" without the full knowledge of the customer as to what the cost to them will be.

Day late and a dollar short, I know, but this is a huge issue.

I had a buddy who was interested in getting a vasectomy. He and his wife put a "not to exceed" value on it and he sat down with the hospital to determine if the all-up price was gonna come in under the "not to exceed" number. He was told "Yep, it'll be right under that."

So he gets the pre-op work done and shows up for the day-before briefing. Again, he asks the cost question to confirm things. Turns out that the "all-in" cost given to him by the hospital was only for the hospital charges. It didn't include the surgeon's fees.

Cancel.

Why is this so hard??

 

[JAWS]

I am Canadian. Healthcare here is NOT free! It is paid for through our taxes, federal and provincial. We are starting to pay for more and more services these days as budgets get tighter and tighter. The system is not perfect and needs updating for the current times, but I like it overall.

I have had one medical emergency in the US and was very thankful for my travel insurance.

 

[James331]

I am Canadian. Healthcare here is NOT free! It is paid for through our taxes, federal and provincial. We are starting to pay for more and more services these days as budgets get tighter and tighter. The system is not perfect and needs updating for the current times, but I like it overall.

I have had one medical emergency in the US and was very thankful for my travel insurance.

I love your country's policy and your government, Ms Traudeu and all, it gives me the merica' 30% off everything discount!!

 

[weilke]

So he gets the pre-op work done and shows up for the day-before briefing. Again, he asks the cost question to confirm things. Turns out that the "all-in" cost given to him by the hospital was only for the hospital charges. It didn't include the surgeon's fees.

Cancel.

Why is this so hard??

Was this the first time ever that he had a medical procedure ? The hospital can only control their part of pricing, depending on what you need there are typically separate bills from the surgeon, the anesthesia provider and sometimes the pathologist.

As a general note, from a pricing perspective, a hospital is the worst place for a cash patient to have a procedure or test done. A privately owned ambulatory surgery center or imaging center is in a better position to give you a binding cash price up front. Hospitals also tend to have much higher charges most incapable to give a decent cash price up front. Locally, there is a factor of 10 between out of pocket cost at a hospital vs. an ASC.

 

[Stephanie B]

Now that everyone has expressed their outrage, I suggest you buy a membership in a flight organization like I did. This is insurance, and it's ridiculously cheap.

My wife and I are covered for four years, and it cost $145. CareFlite covers North Texas and Southern Oklahoma, providing HEMS, ambulance, and fixed wing services.

AirMed covers 38 States and costs $85 per person annually.

Yes, but they sell that as no out-of-pocket costs. If you later have an insurance recovery (negligence, workers com, etc.), they will go after you for their costs. I think there’s a case going on in St. Louis where the injured person is claiming fraud, because the medevac company did its best to hide that provision. Allegedly.

 

[Velocity173]

A few more real world numbers from last weeks hitch. Ground transport for patient in extreme pain 1+00 (at best), did it in 22 minutes by air. Another patient needing a specialized hospital 2+15 (at best) by ground, did it in 40 minutes by air. Beat both ambulances to the LZ as well.

Get a flight program or make sure your insurance pays for air transport.

 

[paflyer]

If I have really low quality health insurance, you could be correct, which I don’t. Even out of network, I have a max out of pocket.

Most people who are not on a dole of some kind have low quality insurance. Thanks, Obama!

 

[paflyer]

I am Canadian. Healthcare here is NOT free! It is paid for through our taxes, federal and provincial. We are starting to pay for more and more services these days as budgets get tighter and tighter. The system is not perfect and needs updating for the current times, but I like it overall.

I have had one medical emergency in the US and was very thankful for my travel insurance.

It's free to people who don't pay any (or little) taxes.

 

[JAWS]

It's free to people who don't pay any (or little) taxes.

We pay GST on almost everything. Then pay PST on top of that. From a pack of gum, to houses. WE all pay!

 

[denverpilot]

A few more real world numbers from last weeks hitch. Ground transport for patient in extreme pain 1+00 (at best), did it in 22 minutes by air. Another patient needing a specialized hospital 2+15 (at best) by ground, did it in 40 minutes by air. Beat both ambulances to the LZ as well.

Get a flight program or make sure your insurance pays for air transport.

Not picking on you too hard, but neither of those sound life threatening.

If either patient were told the up front costs of both they might have chosen ground. Especially the pain patient. Don’t know what specialty the other patient needed, so can’t guess there.

“Ouchie” isn’t worth an additional $30K. If your service was an additional $5K? Depends on how saucy I feel about my investments.

 

[kyleb]

Was this the first time ever that he had a medical procedure ? The hospital can only control their part of pricing, depending on what you need there are typically separate bills from the surgeon, the anesthesia provider and sometimes the pathologist.

The guy was a bit naive and had never had a medical procedure. My opinion is the folks he spoke with at the hospital should have done a better job educating him (it would have taken 10 seconds) when he first approached them.

 

[weilke]

Make sure your plan covers two medevac flights in a week:

https://smnewsnet.com/archives/435677/man-flown-out-from-two-motor-vehicle-accidents-in-four-days/

(and yes, those are both of his cars next to each other in the tow lot)

 

[Velocity173]

Not picking on you too hard, but neither of those sound life threatening.

If either patient were told the up front costs of both they might have chosen ground. Especially the pain patient. Don’t know what specialty the other patient needed, so can’t guess there.

“Ouchie” isn’t worth an additional $30K. If your service was an additional $5K? Depends on how saucy I feel about my investments.

These two patients didn’t have an “ouchie.” I didn’t even give details of the patient conditions. I can tell you on the first one, that the flight paramedic said “kick in the after burner on this one.” When we were through, the flight nurse said “you saved that man’s life.” Now, she might be exaggerating things a bit and obviously every flight isn’t like that but there are plenty that are. Either way, neither patient could have driven themselves to the hospital and as long as it is a “medical necessity” requiring hospitalization and distance or higher level of care enroute is a factor, then a helicopter will be called.

I would think with all the attention air ambulance is getting in the news in recent years that everyone would know roughly what the costs are. At any rate, there’s nothing preventing either the on scene EMS crew or medcrew from giving an estimate to the patient. Actual costs vary and it’s impossible to give before the flight because there’s no telling what procedures will be done enroute, what drugs administered and in some cases, how many miles flown.

And again, I would hope you have decent insurance or a flight program and you won’t have to pay such a high transport fee. I’m not sure where the author got his insurance / Medicare numbers but I’d be willing to bet those have been cherry picked and not random samples. Out of the hundreds of people that I’ve met during PR events, I always meet people that we’ve flown, or their family members. The vast majority of them say their costs were either covered by Medicare or that their insurance paid almost all of the flight. I work with only 2 people (paramedic & nurse) that were flown and one paid roughly $170 out of pocket and the other around $400.

You’re not going to get unbiased reporting when it comes to air ambulance. It has to be either extremely negative in what we do or unrealistically positive. Real life air ambulance is somewhere in between. Of course real life doesn’t sell or make for interesting news so you won’t see a story covering both angles.

 

[James331]

These two patients didn’t have an “ouchie.” I didn’t even give details of the patient conditions. I can tell you on the first one, that the flight paramedic said “kick in the after burner on this one.” When we were through, the flight nurse said “you saved that man’s life.” Now, she might be exaggerating things a bit and obviously every flight isn’t like that but there are plenty that are. Either way, neither patient could have driven themselves to the hospital and as long as it is a “medical necessity” requiring hospitalization and distance or higher level of care enroute is a factor, then a helicopter will be called.

I would think with all the attention air ambulance is getting in the news in recent years that everyone would know roughly what the costs are. At any rate, there’s nothing preventing either the on scene EMS crew or medcrew from giving an estimate to the patient. Actual costs vary and it’s impossible to give before the flight because there’s no telling what procedures will be done enroute, what drugs administered and in some cases, how many miles flown.

And again, I would hope you have decent insurance or a flight program and you won’t have to pay such a high transport fee. I’m not sure where the author got his insurance / Medicare numbers but I’d be willing to bet those have been cherry picked and not random samples. Out of the hundreds of people that I’ve met during PR events, I always meet people that we’ve flown, or their family members. The vast majority of them say their costs were either covered by Medicare or that their insurance paid almost all of the flight. I work with 2 people (paramedic & nurse) that were flown and one paid roughly $170 out of pocket and the other around $400.

You’re not going to get unbiased reporting when it comes to air ambulance. It has to be either extremely negative in what we do or unrealistically positive. Real life air ambulance is somewhere in between. Of course real life doesn’t sell or make for interesting news so you won’t see a story covering both angles.

I think he's got bigger issues than medical bills

That said if your "insurance" doesn't cover a life saving flight, you don't have insurance, you're the victim of a scam.

 

[denverpilot]

These two patients didn’t have an “ouchie.” I didn’t even give details of the patient conditions. I can tell you on the first one, that the flight paramedic said “kick in the after burner on this one.” When we were through, the flight nurse said “you saved that man’s life.” Now, she might be exaggerating things a bit and obviously every flight isn’t like that but there are plenty that are. Either way, neither patient could have driven themselves to the hospital and as long as it is a “medical necessity” requiring hospitalization and distance or higher level of care enroute is a factor, then a helicopter will be called.

I never mentioned driving themselves. The symptoms given weren’t enough to switch to air transport, which got my curiosity up is all.

I don’t doubt the need for those two, it was more of a “If that’s the symptoms, one is a lot more expensive than the other, and some people might be better off in the long run, opting out” comment.

People in the general population a) Don’t know how expensive medical air transport is. b) Don’t look for coverage in their medical insurance. That creates a problem when the bill comes.

Example, I’ve never seen a Medevac pilot or flight nurse at one of those PR events where the aircraft is parked, talking pricing, and you won’t see it on the Marketing created info graphic panels that are set up next to the “ooh, shiny” helicopter at those events. Hahaha.

“You can get a ride in this across town for only $30,000!” Not exactly the Marketing they’re going for. Hahahahaha.

And yeah, I don’t know your operating area, but I understand you’re doing it more rural and further from appropriate care facilities.

Lifesaving aircraft, for sure. Just not cheap. Know two people who’s lives were saved by them, so I get it.

Up until this thread, I’d never heard of the gimmick insurance for getting coverage to fly in one. Amazed at how many people here say they have it. I usually want medical transport coverage when outside the US, but never seen anyone say they had a subscription inside CONUS. Saw a couple of folks say they have it in AK, and that probably makes sense.

 

[Lowflynjack]

I didn't read through all of the comments, but what do you guys think is fair? I'm not arguing that $40K is reasonable, but I'm not sure what is. We're talking about for-profit companies, so can we assume the government is not supplementing them? Are they actually making a profit in the end?

Price estimates by BJT Online

Cost of EC-145 New - $9.7M
Total Fixed Costs per year - $522K
Total Crew Costs per year - $268K (Add $90K for flight nurse.)
Total Variable Costs per year - $436K