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Emergency Transport on the Rim— How does it work and who pays the bill?

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Heber overgaard az
Guardian Air flies out of Winslow, AZ

Living in Rim Country is a great lifestyle filled with the beauty of nature and wildlife along with a sense of freedom that seems to get drowned out in the big cities. However, it comes with some drawbacks, one of which is the proximity to emergency medical care. The Heber Overgaard Fire Department (HOFD) is staffed with paramedics and EMTs who come to the aid of residents as well as visitors in emergency situations. In critical situations, they transport patients via ground or air ambulance to the nearest medically qualified facility which is usually Summit Healthcare in Show Low.

 

Before we begin this conversation, may it be made very clear that in an emergency situation, the most important factor is that the person in distress receive the most appropriate medical care in the most efficient manner. Critical patients shouldn’t be worrying about the cost of their care; just that they get the care they need.

 

Concerning the more common ground ambulance, we may hear from the most well-meaning individuals that the ambulance ride is “free.”  Not so fast according to the Heber Overgaard Fire Chief, Richard Upham. Per Chief Upham, “There is no money exchanged with the ambulance crew, but the cost for ambulance service will be billed to the responsible party’s insurance provider. The cost right now for our ambulance ride is $1,442.68 plus $10.85 per mile. Mileage to the ER in Show Low averages around 40 miles from here.” As an FYI, the rates are set by the Arizona Department of Health Services and can be found posted online at AZDHS.gov.

 

For Heber-Overgaard property owners, whatever payment is received from the patient’s insurance provider is accepted as payment in full. If you have an outstanding deductible or a co-pay, you will not be required to pay that. BUT, this takes place only after you provide written proof of residency, such as a utility bill to HOFD. They may know who you are, but the office is required to maintain a paper trail. This is a small town, but the HOFD and the Ambulance are both regulated industries and require written records. So, if you take the “free (NOT free)” ride, know that you will be asked for insurance and residency information shortly thereafter.

 

(If you qualify for AHCCCS they will be your payor, but if you don’t qualify and have no insurance, your residency would negate your obligation.)

 

During busy times, neighboring Fire Departments may be called upon if all HOFD’s responders are out on other calls. In this case, there are reciprocal agreements with HOFD so residents don’t have to worry about differences in coverage.

 

Non-property owners have a different scenario. Their insurance provider will be billed but any outstanding amounts are the patient’s responsibility.

 

Be aware: if you don’t prove residency and ignore a bill from your friendly fire department, you could be turned over to collections. (NOT free ride)

 

On to the more difficult subject – 

Air Ambulance 

In the event of an accident or the need for an emergency medical service not available at the closest medically qualified facility, (e.g., Summit Healthcare Show Low) the decision may call for either a rotor or fixed wing air ambulance. This is a common occurrence in a rural area such as ours. I’m sure you all know someone who has had to be flown for coronary, gall bladder or even appendicitis emergencies. The Air Ambulance industry falls under the federal Airline Deregulation Act of 1978 and because of this, states have little power when it comes to establishing consumer protection regulations. Deregulation worked great for consumers getting competitive pricing for airline tickets, but it has had the opposite effect for patients’ costs on air ambulances. According to Consumer Reports 1, attempts at regulation by states have failed in the courts and effective changes can only be brought about by Congress. Until that occurs individuals need to find out what their medical coverage pays for and what is their potential for a huge bill should they need to be flown in a medical emergency.

 

There are four air ambulance providers for our area: Native Air, PHI Air Medical, Sunrise and Guardian. The first three fly out of Show Low and Guardian flies out of Winslow. Emergency 911 calls are handled through the Show Low Police Dispatch and when a helicopter is requested by first responders, the dispatch office makes the decision based on location and who is available. Chief Upham told of an incident this summer of a head-on collision to which they responded where two aircraft were requested because of the patients’critical trauma. They got one out of Globe and one from Payson as every other air ambulance that normally would cover this area was busy!

 

There are a few important phrases you should know as you review the language in your policy: 1) medically necessary care; 2) nearest medically qualified facility; and 3) in-network versus out-of-network provider. For a while, people were getting flown for all kinds of reasons and insurance companies and Medicare began to rule in some cases the flight was not medically necessary which puts the patient in a bad spot since they normally have no control over when an air evacuation is called. A study done from 2007-2013 at the University of Arizona 2 found that nearly one third of patients transported by air ambulance were unnecessary. According to Chief Upham, HOFD has reduced their calls for air ambulances by about that same ratio. They are now around 10 per year down from 35 per year in the past. “Criteria for an air ambulance call is basically for critical trauma, pediatrics and burn patients,” said Upham.

 

Some medical insurance providers contract with specific Air Ambulance companies and call them “in-network”. For instance, if your insurance carrier contracts with Guardian and PHI Air Medical, this means if these contracted “in-network” carriers fly you, you are covered, (subject to your specific policy provisions.) However, the patient usually has no choice when it comes to choosing the carrier. Remember, this is done by Show Low Dispatch in the case of an accident. If you’re flown by one of the out-of-network carriers, you most likely would be on the hook for the bill. These bills are increasing each year due to this being a non-regulated industry – they can be upwards of $30,000 or more.

 

It’s also important to note that Medicaid (or AHCCCS in Arizona) has a very low set payment. It doesn’t come close to covering the cost for the flight, including fuel plus costs to retain a professional crew on 24+ hour shifts. The public sector makes up the difference for this shortfall.

 

The only locally owned air ambulance is Sunrise  Air Ambulance which has bases in Show Low and Springerville. According to owner Dr. Michael Hayes, “Sunrise is the only company that has both fixed wing and rotary aircraft in this area. Costs for fixed wing are usually less than helicopter. In inclement weather, a fixed wing is more likely to be able to make a flight where a helicopter would be grounded. Since we are a smaller, local company we treat our patients with more focus on the individual.”

 

It’s very important that you check with your medical insurance provider whether its major medical, Medicare with a Medicare Supplement or Medicare Advantage to see what your plan will pay in the event you need to be flown. Every plan is different – a 20 percent co-pay of a $30,000 flight equals a $6,000 bill – quite a chunk of change. You need to know what your policy will pay and what would be your portion.

 

All four air ambulance carriers in our area offer a membership to residents, but a membership isn’t insurance. Depending on plan specifics, for an annual fee they will accept what your medical insurance pays as payment in full, or if you have no insurance, your bill would be paid in full. Notice some of these memberships are only available if you have insurance.

Promo photo from Sunrise Air Ambulance of one of their fixed wing aircraft.

IMPORTANT NOTE: You must ride on the aircraft with whom you have a membership to receive the benefit. 

  • Sunrise, a local company out of Show Low offers Platinum Plan membership only if you have medical insurance. Cost is $30/year individual and $45/year household. (928) 532-7700
  • Guardian offers Air Med Care Network with medical insurance or not; cost is $65/year for household. (877) 541-2065
  • PHI Air Medical offers PHIcares.com; $50/year household with insurance, $100/year household without insurance. (888) 435-9744
  • Native Air offers Air Methods Advantage for $40/year individual and $75/year household with insurance. (855) 877-2518

 

Guess, if you want to be sure, you could buy a membership from each company which for a household with insurance it would total $285 per year. Depending on your medical plan, that may be a deal (if you need to use it.)

 

Beware of plans that only apply if you’re traveling, not if you’re at the ER in Show Low or on Highway 260 going to the store for eggs. I’ve received mail solicitations as a AAA member but there is no coverage unless we’re on a trip away from home. How confusing is this? Deep breaths…

 

Remember a couple of things, even if you had the capacity to speak your wishes in an emergency situation: 1) You cannot choose the air ambulance company in most cases and 2) In most cases you cannot choose where they take you. Even if you are able to choose a different hospital, you may be personally responsible for the extra mileage. All language is the nearest medically qualified facility. There is no giant database in the sky to keep track of our wishes. In the heat of the moment the EMTs are just trying to save your life. Think about them trying to login onto our fabulous internet on the mountain (Ahem), watching the little circle go round and around while you’re gasping for breath. Think not. The memberships offer a decal for your car but I’m not going to put much hope first responders will see it in a crumpled wreck.

 

What does need to happen is Congress needs to get a grip on this industry and cut the money-sucking cord by giving states the right to regulate on behalf of their citizenry. According to Consumer Reports 1, there are several class action lawsuits in the works trying to get some type of monetary remediation from the private air ambulance industry as well as there seems to be bipartisan support in Congress for making necessary changes.

 

What you should do: Contact your agent or benefits office to find out what are your policy provisions for emergency air ambulance. Once you know that you can decide whether a membership plan would be worth it. Then, ask your Congressional Representatives to take action in regard to the air ambulance industry so consumer protections can be established.

 

Sources: 

1) http://consumersunion.org/wp-content/uploads/2017/04/Up-In-The-Air-Inadequate-Regulation-for-Emergency-Air-Ambulance-Transportation.pdf

2) (https://www.ncbi.nlm.nih.gov/pubmed/25710420)

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Barbara Samples was born and raised in Phoenix, AZ and has called Heber-Overgaard home since 2008. She is married to Larry Samples, who is co-owner with her in L & B, Inc., owner of the Mogollon Rim News. They have four (grown) children and two grandchildren. Barbara serves as the Editor.