You're facing a medical emergency, and minutes count. If you live in rural Missouri or Illinois there's a good chance a physician will order a helicopter to your location. Those helicopter rides aren't cheap.
In 2015, Shirley Burch of Cuba, Missouri called 911 after her husband Earl suffered a stroke. Burch says local medical professionals determined Earl needed to be sent to Fenton using Air Evac.
Air Evac is based in O'Fallon, Missouri and dispatches life saving medical helicopters in 16 states.
Burch was thankful for their help, but shocked when she received a bill for $37,001.50.
The hospital stay was covered by Earl's Medicare Part A, but the Medicare A did not cover the helicopter transport. According to CMS (Centers for Medicare and Medicaid Services) Medicare Part A does not cover helicopter transportation, but it is covered under Medicare Part B.
Burch tells News 4 her husband also had health coverage through the Veterans Administration. The VA also declined payment on the Air Evac Bill. A spokesperson would not comment on the Burch case specifically, but did say the VA will cover helicopter transportation if specific criteria are met. News 4 obtained the following statement: Claims for emergency care from Non-VA providers and emergency transportation companies (to include helicopter transport) are processed for payment in accordance with the Veterans Millennium Healthcare and Benefit Act. The specific criteria outlined in this Act must be met in order for payment to be made.
Under regulation 38 USC 1725, Veterans Millennium Healthcare and Benefit Act, H.R. 2116. The regulations states the following items must be met for VA to consider payment:1. Veteran is financially liable to provider for emergency treatment.2. Veteran is enrolled in the VA health care system and received treatment within a 24-month period preceding emergency care.3. The veteran has no other coverage under a health plan contract that would pay, in whole or part.4. VA facilities are not feasibly available and an attempt to use them beforehand would have been hazardous to life or health.5. Emergency services were provided in a hospital emergency department, a free standing urgent care clinic, or a similar facility held out as providing urgent or emergency care to the public, up to the point of medical stability.6. Claim must be filed within 90 days for discharged date.7. The non-VA facility must be approved and paid before payment can be made for the emergency transportation (38 CFR 17.1003).Burch claims her husband met the criteria above and it's still unclear why her husbands bill wasn't paid.
After News 4 aired Burch's story the president of Air Evac called Burch.
Seth Myers said he waived Burch's entire bill, "essentially this poor woman got caught between two federal agencies." Myers added, "we're there to help."
Air Evac is a for-profit business. Myers tells News 4 the company is in litigation with some insurance providers over reimbursement rates.
Anita Lewis of Aurora, Illinois claims Air Evac transported her husband between Mountain Home, Arkansas and Springfield, Missouri in 2015 following a stroke.
Lewis says her insurance provider, Blue Cross Blue Shield of Alabama, only covered $10,804.20 of her husbands $39,542.30 bill leaving Lewis with a $28,738.10 balance.
A spokesperson for Blue Cross Blue Shield of Alabama provided the following statement: For in-network air ambulance providers, we pay the claim according to the member’s benefits, and the provider is not allowed to balance bill our member for the remaining charge.
For out-of-network air ambulance providers, we pay the claim according to the member’s benefits, but the provider can bill our member for the remaining charge if they choose to do so.
"Unless it's happened to somebody I don't think they are aware of it," said Lewis.
It's important to call your insurance provider to ask if helicopter transport is covered. If your insurance provider doesn't cover helicopter transportation, Air Evac does offer a $65 annual membership that covers every person in your household.
According to an Air Evac spokesperson that membership means the following: If the transported person has insurance then whatever his/her insurance company pays is considered payment in full (no out-of-pocket expenses). If they do not have insurance, they will be billed at the Medicare Allowable rate.
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