ORANGE COUNTY, Fla. - Action 9 learned how health insurance companies can refuse to pay when it is needed most.
A Lake County woman faces a $25,000 medical bill because the emergency care she got was out of network. Surprise bills like the one she received can hurt many local families who would not face that nightmare in several other states.
Ashlynd Anderson is lucky to be walking after the pickup truck she was riding in slammed into a tree near Mascotte in Lake County. She was airlifted to Orlando Health with a shattered leg and foot.
“I don't remember going on the helicopter at all,” Anderson said.
But Anderson said she will never forget the hospital bill. It was $25,000 for just the air ambulance transportation.
Anderson was fully insured, but the company operating the air ambulance was out of network.
Since it had not agreed to pay her Cigna insurance rate it was free to set its own fee.
Anderson could not believe that.
“It's ridiculous how much they charge people, and there’s no way I can afford that,” said Anderson.
Surprise out-of-network bills hit many people who receive emergency care.
Ana Chapin went to the emergency room fearing a stroke. She is fully insured but her provider covered a fraction of the bill.
“Now someone told me I'm out of network. What does that mean?” Chapin asked.
Because the ER doctor and some tests were out of network she has a $2,500 bill instead of $500.
“That $2,000 is at least two months of my mortgage. It's an outrage,” said Chapin.
If Anderson or Ana were treated at an emergency room in several other states they would not be facing those surprise bills now that they cannot afford.
New York and nine other states have passed reforms that ban hospitals and doctors from forcing insured patients to pay out-of-network rates.
Consumer groups pushed for it, saying that in emergencies you can't chose a hospital or doctor.
Charles Bell from Consumers Union told Action 9 out-of-network billing doesn’t make any sense.
“Patients may be unconscious. They may be bleeding uncontrollably, broken limbs. They are in no position to navigate a network at that point," said Bell.
Since 2012 more than 440 patients filed complaints with Florida regulators about out of network surprise bills. So far, Action 9 could find no attempt by state legislators to protect consumers in the state.
Orlando Health said providers don't know who is out of network, the priority is saving lives.
Response from Orlando Health:
Air Methods Corporation provides the aviation services to Orlando Health’s Air Care Team and manages the billing of services.
During life or death situations, the goal of first responders and other health care workers is to help ensure patients are given immediate medical attention for survival and the best quality of life. Providers have no idea if a patient is in-network or out-of-network; the priority is to save a life. We understand the complications of health insurance, the variation in coverage by providers, and the financial impact of health care costs to patients. When considering insurance coverage it is important for individuals and families to become more aware of what their insurance covers, and what it doesn’t cover, both in-network and out-of-network. While none of us hope to ever face a tragic medical situation, emergencies are an everyday occurrence and can result in long-term medical and financial impacts. As a health care provider, and an employer that provides insurance coverage to thousands of team members, Orlando Health works to provide excellent medical care when needed and to help patients and insurance companies with financial concerns as appropriate.
Response from Air Methods:
Due to patient privacy we won’t be able to speak specifically to that transport without the patient’s permission in advance. We can speak on behalf of what makes up our costs, how we bill and why some fees are reduced.
There are quite a number of variables that make up the cost of an air medical transport, including:
- The lift-off fee and a per mile fee.
- The single largest consideration is the cost of 24 hour availability to include salaries, aircraft, scheduled maintenance, medical equipment, insurance, facilities, training, dispatch/communications, and administrative overhead. These costs are by and large fixed in nature and a portion of which must be allocated to each flight. Each flight also consumes fuel, medical supplies, and additional parts/maintenance.
The company has invested more than $100 million over the past five years in advancing safety and technologies in our operations. In 2013, Air Methods became the first helicopter operator and air medical provider to achieve the highest level (Level 4) within the FAA’s voluntary safety management system program. In addition, our air medical fleet is now 100% equipped with night-vision goggle technology, making us the largest NVG fleet in the world, and we continue to expand our full-motion simulation training to enhance the skills of our pilot workforce. Emergencies can happen anywhere and at any time, and we must be ready to respond around the clock.
Air Methods will bill all health insurance, automobile insurance, worker’s compensation, and will make every effort to maximize the amount the patient’s insurance pays to minimize the patient’s out-of-pocket. In the event they don’t have insurance or have a balance due after the insurance has paid, we have several payment options available. For those who can demonstrate the inability to pay, we have a Charity Care Program to bring the costs down to reduce the patient’s obligation.