I-Team investigates sky-high air ambulance bills; how does cost in Maine compare?
STATEWIDE (WGME) — The I-Team investigates patients paying the price for sky-high medical helicopter flights.
In an emergency, it may be the only way to get you the critical care you need, but what's next is often a big bill.
Federal law bans states from regulating air ambulance companies, and we found bills across the country of $30,000, $40,000, even $80,000 for just one flight.
"I'd have to give them a hug. People that were instrumental in saving my life," said LifeFlight of Maine patient Frank Wagg.
Wagg was working on his roof in Madison last fall when he slipped on some moss and fell to the ground.
He was taken by LifefFight to Central Maine Medical Center in Lewiston.
Wagg is one of about 1,800 patients in Maine who flew in a LifeFlight air ambulance last year; he received emergency treatment for a punctured lung, broken bones, ribs, and pelvis.
After two major surgeries, Wagg is now in rehab and back on his feet for the first time in months.
He says the most painful part came during his first week in the hospital: the bill for his medical helicopter ride.
"Fifty-two miles was $12,547. It didn't take long to commit that to memory. Wow, biggest bill I ever got in my life for anything," Wagg said.
His records show that months later, he's still trying to get his insurance company to pay the bill; he said it was initially denied for not getting prior approval.
"I kinda chuckled because because how can you pre-authorize a LifeFlight? You just ain't going to wait for an insurance company to say go," Wagg said.
LifeFlight of Maine Executive Director Tom Judge said pre-authorization and payment are challenges of the American healthcare system, but they work closely with insurance companies and patients.
"We're going to take care of everyone and then we're going to sort it out afterwards. If an insurance company raises a question saying 'was this medically necessary?' We have to lay out why it was medically necessary," Judge said.
He said while there's no denying it's a complex industry, with high costs, patient charges in Maine are among the lowest in the country.
"We had to design a world class system built on the economics of Maine," Judge said.
According to billing records, the average cost for a LifeFlight in Maine is about $12,000; that's a fraction of the nationwide average for an air medical transport, an estimated $34,000.
"We're high end medicine. To have something that costs $12,000 in Maine and $60,000 for the same service in New York, you've got to scratch your head," Judge said.
Lifeflight of Maine is part of a small group in the helicopter industry, running as a non-profit. Judge said that structure helps keep overhead costs low and charges fair, but he understands, the bill after the flight might still give some Mainers a case of sticker shock.
"This is a high fixed cost; helicopters are expensive," he said.
Still Frank Wagg said even if he had a choice, he wouldn't have changed a thing.
"I can tell you they're worth it. I don't think I'd be standing here talking to you," Wagg said.
Wagg's insurance company pointed us to policy documents showing "air ambulance" service requires prior approval but also said exceptions may be made for emergency situations.
The National Association of Insurance Commissioners said most insurers will pay what they deem "reasonable use" of an air ambulance, but may not but cover the full cost.
The Association suggests:
- Check your policy
- Understand what's covered
- Get pre-authorization whenever possible