Is Air Ambulance Service Coverage Necessary for Events?
23 Mar, 2020By: Mary Helen Sprecher
When problems with athletes at the international level make the news, it’s easy to think they don’t affect sports events within U.S. borders. But those issues can (and do) come home to roost.
Increasingly, the U.S. has been hearing about scams in Nepal, in which climbers affected by altitude sickness are airlifted to clinics – after which, the helicopter service bilks insurance companies out of tens of thousands of dollars, generally while engaging in dishonest practices, such as claiming they made two trips for two separate patients – while both patients were carried in the same helicopter but instructed to tell the insurance companies they were alone. (There’s a lot more unscrupulous behavior described in that link, by the way, including intentional food poisoning that will necessitate urgent medical care).
The problem of (ahem) sky-high costs for airlifts, however, isn’t limited to those trying to scale Mount Everest. Even in the U.S., the cost of airlifting a patient to receive emergency care is often not covered by regular insurance, as many are finding out. Is there anything an event owner can do, particularly when using a venue where medical care may not be readily accessible? What about a ski competition, an orienteering event or an endurance mountain bike race conducted in the back country? For that matter, what about a competition that happens close to home but causes an unexpected life-threatening injury – or one that is best addressed by a specialty hospital?
NPR did a case study of a nine-year-old boy who fell while hiking in Virginia’s Blue Ridge Mountains, not far from his home in Roanoke. Among the fractures he sustained: both bones in his lower left leg, his wrist, both sides of his nose and his skull. He was airlifted out to a nearby pediatric hospital. The air ambulance company, which was not part of the family's health plan network, billed his parents $36,000 for the 34-mile trip from the mountain to the hospital. It was greater than the cost of his two-day hospitalization, scans and cast combined.
Unfortunately, it’s hardly an exceptional case. In fact, NRP notes, the rising number of complaints about surprise medical bills is spurring efforts on Capitol Hill and at the White House to help consumers. Unfailingly, the high cost associated with air ambulance service gives patients the biggest sticker shock — and the subject has come up at nearly every Capitol Hill hearing and news conference on surprise medical bills. It was studied in the last session, in fact, but nothing came of it.
Airlift services report that reimbursements from Medicare and Medicaid do not cover the cost of providing services. So charges to private patients, they tell lawmakers, must make up that difference.
NPR additionally notes that more than 550,000 patients a year receive medical airlifts, according to industry data, and in many rural areas, air ambulances are the only quick method of moving critically ill or injured patients to trauma centers and burn units. As more than 100 rural hospitals have closed around the U.S. since 2010, the need has increased for air services.
So what can sports event owners do? If a crisis takes place and an athlete needs immediate medical care an airlift may be the fastest way to get it. Is there any special planning that can be done in order to get the care necessary – but have it covered?
The short answer: Unless you have a helicopter parked at your event venue, it’s not that easy. And while having good event insurance is always necessary, it generally will not cover airlifts (though checking with your carrier is always recommended).
Individuals who register for an event (particularly one where medical care may not be easily accessible) can be encouraged to purchase medical evacuation travel insurance (also called air ambulance coverage), which specifically covers air ambulance services. (Information from various companies that provide this coverage can be found on the Internet; one example is here).
According to The Balance, air ambulance coverage may also be included in health insurance or travel insurance policies, particularly if it is deemed medically necessary to transport the injured individual to the appropriate facility. Those who want to safeguard themselves should review all insurance, including travel insurance and healthcare insurance coverage, in advance to make sure their policy covers air ambulance service; they should also understand in advance out-of-pocket expenses, deductibles and other factors.
Be advised, however, that many forms of insurance will cover a number of specific air ambulance companies – which may not be the one in the jurisdiction where an event is taking place, leading to what are called out-of-network costs and putting the user, for all their precautions, back in the position of owing tens of thousands of dollars.
In fact, the NPR article notes, according to a recent report from the Government Accountability Office, two-thirds of the more than 34,000 air ambulance transports examined were not in the patients' insurance networks. (Unfortunately, those who are injured seriously enough to warrant air transport are in no condition to ask before takeoff whether or not the flight is in their network – and in the case of a youth event, neither are the parents, generally speaking.)
In the worst-case scenario, a participant in your event is injured and is airlifted out. The family may be subject to charges. ABC News offers these tips to those receiving the bills:
• First, let the insurer’s process play out. Blue Cross Blue Shield of Texas first completely denied the claim of a man who was airlifted after becoming seriously injured when riding an ATV. But he looked closely at his policy and saw that the threat of loss of limb (the nature of his injury) was explicitly covered. He appealed, and that’s when the insurer paid $11,972.
• Second, negotiate! The air ambulance company might be willing to negotiate a settlement for a fraction of the bill to avoid turning to debt collectors, who would pay them pennies on the dollar.
In fact, in the case of the nine-year-old mentioned in the NPR story cited earlier, the boy’s mother noted that her insurance company ultimately paid about a third of the air ambulance bill, and the family settled with the company, agreeing to pay $4,400 out of pocket.
Additionally, it may be advisable to consult the attorney for your event in advance regarding any wording that should be put on the registration website or other materials regarding the limits of the event’s responsibility, and noting that further coverage should be investigated by the participant.