Canandaigua (WSYR-TV) - Emergency rescue companies answer life-saving calls, but they have almost no say in whether or not they will be paid for their services.
Last week, NewsChannel 9 presented one of Your Stories: John Ballard was badly hurt
while cutting wood and then taken to the hospital via Mercy Flight, but his insurance company declined to pay for it and Ballard was stuck with a $12,000 bill that he can’t pay.
Ballard isn’t alone, according to Mercy Flight. The non-profit has to write off $2-million each year in unpaid customer bills.
Ballard – and many other such victims – don’t ask to be flown. In Ballard’s case, paramedics ordered in the helicopter because they determined that he was bleeding badly enough. But Blue Cross/Blue Shield said it wasn’t necessary.
"They're sitting in their offices making this decision, while out in the field blood is all over the ground, all over me, and the side of my scalp is laying over,” Ballard said.
For privacy reasons, Mercy Flight can’t talk about Ballard’s case specifically, but the company says insurance refusals are a major issue for them. They say refusals range from the trip not being medically necessary or injuries that aren’t considered catastrophic.
"We consider that to be very narrow minded because the bottom line is, does that mean someone has to be on death's doorstep before they can get a helicopter,” said Neil Snedeker, of Mercy Flight.
Snedeker says air-ambulance service is expensive. Crews must be available 24 hours a day, every day of the year. In addition, the helicopters must be insured whether they fly or not and the state lays out guidelines for ground crews to make sure air ambulance is necessary.
"Our philosophy is if the ambulance crew has determined they need a helicopter, we're going to transport that patient because they had a reason to believe that,” Snedeker said.
Snedeker says Mercy Flight never worries about payment at the time of the call, they worry later when they send out the bill. He says they see insurance cover all, part, or none of the bill. However, some victims do not have insurance.
"We certainly hope people aren't making decisions, medical care decisions, based upon costs. We know insurance companies want us to, but we're talking emergency situations where time could literally be life,” he said.
If the victim is aware and alert, medical personnel can give them the option of refusing air ambulances.
Although they give the patient the option of ground transportation, medical personnel will still explain the risks. If the patient still insists on ground transportation, the Mercy Flight medical personnel will go with the ambulance ground crew because of their critical care background.
If the insurance company refuses payment, the patient can launch an appeal. After a couple of internal appeals, one can go to the state for review. But the finance department’s policy is to only review what the insurance company has looked at. Snedeker says they can’t speak with them, but must live by their decision.