The $40,000 ambulance ride: Behind LifeNet's bill

April 14--Excitement over the arrival of air medical service in the north country has given way to sticker shock.

Air Methods, Englewood, Colo., brought a LifeNet medical helicopter to bases in both Dexter and Potsdam last year, but with that service came a hefty price tag: $30,000 to $40,000 per flight on average. Air Methods officials recently explained the expense, and said LifeNet patients most likely wouldn't pay the full amount.

"Volume is a big piece of it," said Craig M. Yale, vice president of corporate development for Air Methods.

The higher the volume of transport calls, the lower the cost of a flight will be. LifeNet has completed a combined 210 calls since it began operations at Watertown International Airport on June 1 and at Potsdam Municipal Airport on Oct. 1, Air Methods spokeswoman Tracey Budz said. The Northern New York service receives fewer calls than other regions, Mr. Yale said. The more calls completed in the north country, the less expensive they will be, he said.

Residents of Jefferson, Lewis and St. Lawrence counties had gone without medical helicopter transportation since 2007, when Fort Drum's Military Assistance to Safety and Traffic program was reassigned to Fort Lewis, Wash. The program annually flew about 60 critically injured people from the north country to Upstate Medical University, Syracuse, or other Level 1 trauma-care facilities.

the bill breakdown

LifeNet charges are regionally based, and they vary by market. Bills are broken down into two figures: one for a lift-off fee and one for mileage. The per-mile fee for Northern New York is about $200, Mr. Yale said. That means a 64-mile flight from Samaritan Medical Center to Upstate Medical would cost about $13,000 in mileage, Ms. Budz said. The total cost of the trip would be about $33,000, she said, without giving specifics about the lift-off fee.

Why so much? Aside from the lower number of calls compared with other areas, each base must be staffed and equipped with supplies so LifeNet helicopters are ready to go at a moment's notice. Critical-care supplies kept on each flight include oxygen, airway resuscitation equipment, heart monitor/defibrillator, suction, IV pump and fluids, specialized monitor/testing equipment, ventilators and emergency medications.

Other costs include fuel, medical supplies, additional parts and maintenance and salaries for pilots, flight nurses and flight paramedics. Each local LifeNet crew comprises four pilots, four registered nurses, four paramedics and two maintenance staffers. In addition to the pilot, one R.N. and one paramedic are aboard every flight.

Air Methods's cost of operating a base, Ms. Budz said, is $1.5 million to $2 million per base, per year. That is driven primarily by staff salaries, aircraft ownership costs, hull insurance and general and administrative expenses.

"Despite what may seem to be high charges, after deducting our expenses, we end up with a very modest profit by business standards," Ms. Budz said. "We must have some profit to exist, but more importantly we use this income to support sustainable compliance with industry safety and accreditation standards."

Charges are evaluated on a regular basis, and must be "adjusted to compensate for unrecovered cost from Medicare, Medicaid, charity and bad debt," she said.

Flights are billable to insurance companies, so LifeNet patients may not pay the full amount shown on their bill. Out-of-pocket cost will depend on insurance coverage.

"Air Methods will bill all health insurance, automobile insurance, workers' compensation, Medicare and/or Medicaid and will make every effort to maximize the amount insurance pays," Ms. Budz said.

insurance MAY pay

David G. McGrath can attest to that. The Clayton resident's 13-year-old son was transported via a LifeNet helicopter Jan. 9 from Thousand Islands Middle School, Clayton, to Upstate Medical University for what was deemed a head injury. Mr. McGrath said his son was in the emergency room for 14 hours before being released.

Since his son had lost consciousness, Mr. McGrath said, he does not recall being loaded onto the helicopter or being treated in the air. He came to as the helicopter prepared to land. Mr. McGrath said he wasn't given any information from medical staff about the flight, but at the end of February he received a LifeNet bill for $42,407.16.

He said little information was on the bill, and only two charges were listed: $23,587.96 for a "helicopter rotor base" fee and $18,819.20 for mileage for the 80-mile trip from Clayton to Syracuse. Luckily, Mr. McGrath said, his medical insurance, Tricare, covered all but a $20 copay.

LifeNet was brought to the community through the help of many partners, including the Fort Drum Regional Health Planning Organization. Executive Director Denise K. Young said bringing air medical service back to the north country, not its cost, was the agency's primary concern.

"We did know they'd bill," she said. "It's a service. We weren't looking for it to be taxpayer-funded. They did indicate they'd work with people. They're looking to provide service that saves lives. At that moment if it's to save your child's life, I don't think any one of us would question the cost."

On average, Ms. Budz said, 13 percent of LifeNet patients are uninsured, and 15 percent have no means to pay. Air Methods will work with an uninsured patient on payment options, and there also are programs "for qualified applicants that can reduce the obligation," she said.

Since the inception of both local bases, she said, flights have taken pediatric to geriatric patients suffering from critical medical conditions to critical traumatic injuries suffered in accidents. As per state protocol, patients from scene calls are flown to the "closest appropriate facility."

Trauma patients are taken to hospitals in Syracuse, Utica or Burlington, Vt. For hospital-to-hospital, or inter-facility, requests, LifeNet works with the following hospitals: Albany Medical Center; CVPH Medical Center, Plattsburgh; Columbia Presbyterian, New York City; Crouse Hospital, Syracuse; Fletcher Allen Health Care, Burlington, Vt.; St. Elizabeth Medical Center, Utica; St. Joseph's Hospital, Syracuse; Strong Memorial Hospital, Rochester, and Upstate Medical.

The decision to transport a patient via LifeNet is made by a physician or emergency medical services authority on the scene of an accident or at a hospital, Ms. Budz said.

"When treating a patient at the scene of an accident, limited information about the patient's condition is available," she said. "With the best interest of the patient in mind, it's always best to err on the side of caution and treat for the worst."

As part of Air Methods's continuing education efforts in the marketplace, Ms. Budz said, company officials encourage "appropriate utilization of air and do not support overutilization of air when it's not necessary for the patient's condition."

Each flight goes through a utilization review, she said.

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