When Bob and Marjean Taylor went to stay in a friend’s cabin an hour from the nearest hospital back in 2022, neither expected that Bob would have his second heart attack within four months while they were vacationing. Unfortunately, that’s exactly what happened.
Marjean took him to the local hospital, but they were told he needed more care than the facility could provide. An air ambulance arrived, transporting him to a medical center where his cardiologist was waiting to repair a stent that had torn. The procedure saved his life, but sadly, Bob’s troubles weren’t over.
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Soon after they returned home, the Pueblo, Colorado couple received notice that their insurer, Anthem Blue Cross Blue Shield, was denying their claim for the air ambulance, saying the transport wasn’t medically necessary and sticking the Taylors with a bill totaling around $94,000.
“It gave me a heart attack, almost,” Marjean told Denver7 Investigates of the unexpected bill.
Unfortunately, air ambulances have become very expensive, and a growing number of insurers are denying claims for them, leaving Americans who’ve suffered medical crises holding the bag. Here’s what you need to know.
Air ambulances save lives, but at a huge expense
Air ambulances are helicopters or planes designed to provide timely transport of patients to medical facilities. They’re often used in rural areas where medical care is scarce.
With an aging population, more people relocating to remote areas during COVID-19, and the increased prevalence of infectious diseases, the market for air ambulances is growing.
In fact, according to Technavio, a market research group, the air ambulance market saw 9.63% year-over-year growth from 2022 to 2023 and is expected to increase by $6.77 billion between 2024 and 2026.
Sadly, prices for air ambulances have skyrocketed, as a growing number of private equity firms have moved into the market.
Insurance companies often don’t want to pay
One would think that insurance companies would cover the costs of air ambulance services in most cases, since they’re almost always called in an emergency. Unfortunately, data shows a growing number of insurers are denying claims.
Part of the problem is that when an air ambulance is called, patients aren’t checking if the company is in-network or not. This may not be a high priority when you’re being airlifted to a hospital during a heart attack or in the wake of an accident.
It shouldn’t matter if the ambulance service is in-network, as starting in 2022, policyholders were supposed to be protected from unexpected bills under the No Surprises Act.
This act prohibited surprise bills for:
- Most emergency services, regardless of whether they’re in network or out-of-network
- Out-of-network services provided when a patient visits an in-network facility (such as anesthesia administered by an out-of-network anesthesiologist at an in-network hospital)
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However, insurers can still pass on out-of-network costs to claimants if the service isn’t considered medically necessary. Perhaps unsurprisingly, insurers now claim that many ambulance trips aren’t needed. In fact, the National Association of EMS Physicians warned policymakers in a February 2024 letter that they have seen a “spike in denials of claims on the basis of ‘lack of medical necessity.’”
Being transported to a hospital during a heart attack seems pretty necessary — and yet the Taylors were still told they had to pay. They had to go through multiple appeals over two years and ultimately get the press involved before their insurer finally resolved the issue, blaming unclear communication for the problem.
Not everyone will be lucky enough to get the press involved, though, and the couple faced a lot of stress in the meantime.
“I just felt like we were stuck in the middle of all these companies and nobody cared,” said Marjean.
“After I got off the phone, I said, ‘I cannot believe this is done,’ and I started crying. But I wasn’t giving up. I was not going to give up. I was not paying for it.”
How can you avoid big health care bills?
Air ambulance costs are a growing issue, but there are other ways you could find yourself stuck with a hefty bill for health care services.
Here are some steps you can take to protect yourself:
- Get pre-approval for medical services from your insurer in non-emergency situations
- Know your rights under the No Surprises Act
- Shop carefully for the right insurance policy that offers comprehensive coverage from a provider with a good reputation
- Visit in-network providers whenever you have the option
- Request itemized bills to understand what you’re being charged for
- Negotiate with providers and the billing department if you think you’re being overcharged
- Appeal denied claims, and be prepared to provide documentation
- Hire a medical bill advocate to help you fight unfair bills
These steps can help you avoid the financial devastation that comes with big medical bills your insurer should pay for, but does everything possible to avoid.
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This article provides information only and should not be construed as advice. It is provided without warranty of any kind.
