Editor's note: This popular story from the Daily Briefing's archives was republished on Oct. 28, 2019.
When an accident left Naveed Khan with a nearly "6-inch-wide exposed flesh gap" on his forearm, doctors in Wichita Falls determined Khan needed to be immediately transported 108 miles to a trauma center for surgery in Fort Worth or risk losing his arm.
One helicopter ride and eight surgeries later, Khan, a radiologist, made the decision to amputate and get on with his life—and then a $56,603 bill for the air ambulance flight arrived, NPR's "Shots" reports.
Khan was driving an all-terrain vehicle in circles on a trail along Red River in Texas when the accident occurred. Khan said, "As soon as I turned to the side where my body weight was, this two-seater vehicle ... just tilted toward the side and toppled." The vehicle landed on Khan's left arm.
Khan said, "I had about a 6-inch-wide exposed flesh gap that I could see below, on my forearm. And I could see muscle. I could see the fat. I could see the skin. The blood was pooling around it."
Khan arrived at United Regional Health Care System's ED in Wichita by ambulance. But doctors said the injury was too severe to treat there and that Khan's best chance of saving his forearm was to travel the 108 miles to John Peter Smith Hospital in Fort Worth, the closest Level I trauma center.
Khan said he recalls asking the physician how much it the air ambulance would cost and whether his insurer Blue Cross Blue Shield of Texas would cover the bill.
Khan said, "I think they told my friend, 'He needs to stop asking questions. He needs to get on that helicopter. He doesn't realize how serious this injury is." He ultimately got on the Air Evac Lifeteam's air ambulance.
At John Peter Smith Hospital, Khan underwent eight operations to try and save his forearm, but after weeks in the hospital, he ultimately decided to forego more procedures and asked doctors to amputate his forearm.
The $50,000+ air ambulance bill
Three days after the accident, Khan received his first phone call from Air Evac Lifeteam. According to Khan, the company estimated his bill for the flight would be about $50,000 and asked how he would pay.
The final bill totaled $56,603. His insurer originally refused to cover any of the bill, but later agreed to pay $11,972 after Khan appealed and discovered that the insurer covers care related to the loss of a limb.
The air ambulance company is billing Khan for the remaining balance of $44,631, "Shots" reports.
The rise of air ambulances—and their prices
Khan's experience reflects the rising cost of air ambulances and the limitations states face in regulating such costs, "Shots" reports.
According to a Government Accountability Office (GAO) report, the average charge for a medical helicopter flight increased from $14,000 in 2010 to $30,000 in 2014. For one air ambulance company, Air Methods, the average charge increased from $13,000 in 2007 to $49,800 in 2016, "Shots" reports.
One driver of rising costs, Ira Blumen, a professor of emergency medicine and director of the University of Chicago Aeromedical Network, said, is that the number of air ambulances available today has outgrown demand for their services.
According to Blumen, in the 1990s each air ambulance averaged more than 500 flights per year, but in 2002, a private industry boom significantly increased the number of medical helicopters. Today, Blumen said, each helicopter carries about 350 patients each year.
Another factor behind the price hikes is a lack of regulation, "Shots" reports. Under the 1978 Airline Deregulation Act, air-ambulance providers are considered air carriers—much like Delta Air Lines or American Airlines—and as a result face very few restrictions on what they can charge, "Shots" reports.
Shelly Schneider, a spokesperson for Air Evac Lifeteam, argued that air ambulances have raised the prices of flights to compensate for the low Medicare and Medicaid reimbursements.
According to "Shots," Medicare on average pays $4,624 per ride plus $31.67 a mile—which ends up averaging $6,556. In most states, Medicaid reimburses less than Medicare for air ambulances.
Schneider said the air ambulance industry has been pressing lawmakers to increase Medicare reimbursements.
According to "Shots," two bills are currently pending in the House and Senate to raise Medicare reimbursements for air ambulance, but neither has seen much traction.
As for Khan, he has authorized his insurer and Air Evac Lifeteam to negotiate over the remaining balance of more than $44,000. He also is considering appealing his bill to the state's Department of Insurance. (Kodjak, "Shots," NPR, 9/25; Fortier, "Shots," NPR, 9/26).
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