Imagine getting a surprise “out of network” bill for an air medical transport… for an amount higher than the cost of the aircraft itself. 

Price gouging patients at their most vulnerable, it seems the air ambulance industry is long overdue for a reckoning. Dr. Marty Makary wrote about it in his upcoming book The Price We Pay, so pre-order it here, it’s a must-read. Supporters can see my full interview with Dr. Makary here.

Hey what’s up ZPac, it’s your boy ZDoggMD, Dr. Zubin Damania. Okay, I recently had a guy on the show that’s gonna be released soon, Dr. Marty Makary, he is a professor of surgery at Johns Hopkins and wrote a new book The Price We Pay about how the medical industry is price gouging everyone and how we as clinicians can actually do a lot better to shine some light on this and make it better for patients and caregivers.

Now one of the chapters in this book- it’s coming out in September, we’ll put a link in the thing- is about air ambulances. Now, my paramedics and my EMS crew understand the importance of air ambulances, transporting very sick and injured patients, often from hospital to hospital under predictable conditions, or in an emergency situation where you have a trauma on the highway, you’re in the middle of nowhere. You’re in rural areas. These are crucial life-saving flights.

But, it used to be that a lot of the hospitals owned the helicopters and ran these programs, either at break-even or at a loss because they were bringing in very complex patients and that would pay for the program, but over time, as is the American way, private equity investors started to look at these and go, you know what, I bet we could buy these helicopter programs, launch our own for-profit air ambulance groups with private equity backing it, and actually bill separate of the hospital bill, direct to insurance and make a lot of money. And you know what, they were right. Because it turns out a lot of the air ambulances are out of network for patients’ insurance, not true for Medicare and Medicaid, but every other private insurance often has a narrow network, so what ends up happening? The patient has a disaster, crashes their motorcycle, ends up on a life flight, and these air ambulances companies actually compete for business so they’re like giving… flying in pizzas for physician crews so they’ll get referrals. At one scene, that he describes in the book, an accident scene, seven different helicopters landed all trying to get the business. That’s how lucrative it is, why?

Because the patient gets transported to the hospital, months later gets a bill, hospital bill, most of it covered by insurance, some surprises there, the usual. Air ambulance bill, separate. This is the portion of your bill that is not covered by insurance, $50,000, $100,000. There was one bill for $632,000 for a aircraft flight. The cost of the aircraft was $500,000. And the patient gets this bill in a moment when they’re vulnerable. They have no decision to make. It’d be like you’re driving out in the country, your car breaks down, one tow truck guy shows up, says I’ll take it to town for you. I’ll bill you later. And before you can get your car back, he says here’s a bill for $30,000. If you don’t pay it, I’m gonna put a lien on your house. I’m gonna destroy your credit. I’m gonna send bill collectors after you and, by the way, you’re an average American, you have $400 in your bank account. And then you wonder why the majority of bankruptcies in this country are medically related. So you get this surprise bill and you don’t know what to do. This is unconscionable. It’s a kind of financial rape that these companies are perpetrating on patients when they are at their most vulnerable.

So how and here’s the worst part. If you look at the safety of the air ambulance industry over the years, the vast majority of the accidents looked at were for-profit companies because there are no quality requirements. They can fly older aircraft. They can fly in bad weather. They can do the kinda things that put these heroic crews of doctors, nurses, EMT’s, and support staff, and pilots at risk. And I get these messages when one of these aircraft goes down from people who are, they are in shock that they’ve lost colleagues and friends and family in these accidents and to think that maybe that flight wasn’t necessary because a lot of these aren’t emergencies, or it went up to make a dollar at the risk to the crew, it’s disgusting and we can’t stand for it.

So how can we fight back? Well, first of all, sunlight is the best disinfectant. What if we actually publish all the fees that these air ambulances are charging? Every time there’s a surprise bill to a patient, put it up on a website, with the company’s name, as a badge of shame. Oh, and any complaint against these companies should be public and easily available and then when it’s an elective flight, when you’re transferring from a hospital to another hospital or some other elective flight, you may have an hour to make a decision, there are companies like Sentinel that’ll actually go out and compare bids, and you know what’s crazy, there’s actually market forces at work when they compete where the bids are absolutely reasonable, 2,000, 7,000, $10,000 for a flight that someone else will bill you $500,000 for. Tell me that we have a free market in this. It’s not true. If we actually let America do what America does which is competition, price transparency, and actually the ability as a consumer to file complaints and have them be heard and have impact, we would transform this industry. Now there’s still hospitals like Geisinger in Pennsylvania that own their own helicopters, maybe even operate it at a loss, and so maybe that’s the answer, right. Maybe we should tell these private equity investors if they don’t clean up their act, they’ll be regulated out of existence, but here’s your chance, do the right thing, for our patients, for each other, you can do well financially by doing good for patients.

All right, guys, do me a favor, pre-order this book if you haven’t. It’s amazing. Hit share, hit like, join the Supporter Tribe, we’ll go deeper on this stuff and we out.

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