Large air ambulance bill post retirement

[Salim]

DH and I embraced the Mustachian lifestyle later in life than most forum members; we were able to retire only a few years early. We switched to light part-time work and have been loving it.

Then, about six weeks ago, I was in a terrible accident that left me with a broken sternum, seven broken ribs, and collapsed lungs. A nurse practitioner, one of the first people on the scene, took charge and called the EMTs. I was carried by litter to an ambulance which drove me to an air ambulance (helicopter). I was flown to a level 1 trauma center where they saved my life. I was in the hospital an extra week due to pneumonia from a chest tube.

Blue Cross Medicare Advantage PPO (Massachusetts) is covering the bulk of my hospital bills, but they have agreed to pay only $3,500 of the $41,563 bill for the air ambulance (owned and operated by Rocky Mountain Holdings). It looks as if we may need to pay the difference, which would be a sizable dent in the stash. Of course, I am glad to be alive... and we will tighten our belts if need be.

Has anyone else on the forum had a similar air ambulance experience? Is it possible that the insurance company might pay more or Rocky Mountain might adjust the fee? We don't qualify for Medicaid. Any suggestions?

[Roland of Gilead]

I bet the air ambulance fee is normally negotiated down quite a bit from that $41k, which seems very high for what, two hours of helicopter time and a couple of EMTs?   Something in the range of $10K to $15K would be my guess as to what they normally would accept, but then again, those rattlesnake venom antidotes are billed at $50k or more so who knows what is normal?

[Salim]

I think the actual ride in the helicopter was only 15 or 20 minutes.

[CowboyAndIndian]

 Hope you are better now and recovering.

Sorry to hear about your troubles.

Looks like this is a common issue with air ambulances
http://www.nytimes.com/2015/05/06/business/rescued-by-an-air-ambulance-but-stunned-at-the-sky-high-bill.html?_r=0
http://www.theatlantic.com/health/archive/2016/01/air-ambulance-helicopter-cost/425061/

Wish you the best in your fight with these extortionists!

[Salim]

I bet the air ambulance fee is normally negotiated down quite a bit from that $41k, which seems very high for what, two hours of helicopter time and a couple of EMTs?   Something in the range of $10K to $15K would be my guess as to what they normally would accept, but then again, those rattlesnake venom antidotes are billed at $50k or more so who knows what is normal?

Normal does seem to be a moving target. We'll have to see if they would be willing negotiate.

[Salim]

Hope you are better now and recovering.

Sorry to hear about your troubles.

Looks like this is a common issue with air ambulances
http://www.nytimes.com/2015/05/06/business/rescued-by-an-air-ambulance-but-stunned-at-the-sky-high-bill.html?_r=0
http://www.theatlantic.com/health/archive/2016/01/air-ambulance-helicopter-cost/425061/

Wish you the best in your fight with these extortionists!

Thanks. I'm a little better every day. I can breathe and talk at the same time now, but still very tired.

Thanks for the great links, too. Those are better articles than I found; they explain things pretty clearly. The huge profits made by the for-profit air ambulance companies are bad news for patients.

[minority_finance_mo]

Definitely an opportunity to flex those negotiating skills. In situations like this, the default option should be to negotiate add see how low they're willing to go.

[PVkcin]

I don't have experience with Air Ambulance, but I have experience with hospitals (I have worked for two hospitals / currently work for a hospital - I have a son that had leukemia and other health issues, so we are at the hospital/clinics often as patients too).

With many hospital bills, they give people who have no insurance (or where insurance doesn't cover) a 25% "self-pay" discount.  After they take the 25% off, then my hospital offers 10% off if you pay the whole balance in full.  That 10% if paid in full isn't advertised - I only knew about it because of my job in the hospital. You had to ask for it.

If I were you, I would start by calling the company and explaining you guys don't have a ton of income. Start talking about making the minimum (AKA small) payments, so they think you're going to drag this on for years and years.  Then ask about the self-pay and paid in full discounts.

[HPstache]

Doesnt your policy have an out of pocket maximum?  Or is it that the air ambulance comany was not in network or the bill not counted toward your out of pocket max?

[Salim]

I don't have experience with Air Ambulance, but I have experience with hospitals (I have worked for two hospitals / currently work for a hospital - I have a son that had leukemia and other health issues, so we are at the hospital/clinics often as patients too).

With many hospital bills, they give people who have no insurance (or where insurance doesn't cover) a 25% "self-pay" discount.  After they take the 25% off, then my hospital offers 10% off if you pay the whole balance in full.  That 10% if paid in full isn't advertised - I only knew about it because of my job in the hospital. You had to ask for it.

If I were you, I would start by calling the company and explaining you guys don't have a ton of income. Start talking about making the minimum (AKA small) payments, so they think you're going to drag this on for years and years.  Then ask about the self-pay and paid in full discounts.

I hope your son is doing well now. Sounds like he has been through a lot, and you with him.

Thank you for sharing about how you approached negotiations about hospital bills. This information could be very helpful to us!

[Salim]

Doesnt your policy have an out of pocket maximum?  Or is it that the air ambulance comany was not in network or the bill not counted toward your out of pocket max?

I do have an out of pocket maximum with my policy, but the air ambulance company also says I have to pay the difference if the insurer doesn't pay the whole bill. It's confusing. We'll try to get some more information from the insurer before we call the air ambulance company to discuss the bill.

[arebelspy]

Sorry to hear about that.  I'm glad you are okay!

I have no advice, unfortunately, but I'm curious now.

Please let us know how this turns out.

[Metric Mouse]

Doesnt your policy have an out of pocket maximum?  Or is it that the air ambulance comany was not in network or the bill not counted toward your out of pocket max?

That's generally the rub - insurance companies and air ambulances can rarely agree on pricing, so they're often out of network.  Some states are moving to force air-ambulances to become in-network to keep down the price gouging; but this may be in violation of Federal law. It's a complex issue, to be sure.

[former player]

Extraordinary sums being charged.  If I'm ever in the US I'll be sure to check my insurance covers air ambulances.  In the UK air ambulances are generally charities, well-coordinated to avoid duplication/provide back-up, and free at the point of use.  A friend of mine had a ride in one a year ago after falling unconscious with a brain bleed (she has recovered excellently) and her walking group has made it their charity this year, but there is no requirement or expectation of payment.  I prefer our system.

[Metric Mouse]

Extraordinary sums being charged.  If I'm ever in the US I'll be sure to check my insurance covers air ambulances.  In the UK air ambulances are generally charities, well-coordinated to avoid duplication/provide back-up, and free at the point of use.  A friend of mine had a ride in one a year ago after falling unconscious with a brain bleed (she has recovered excellently) and her walking group has made it their charity this year, but there is no requirement or expectation of payment.  I prefer our system.

Part of the issue is the USA has over 40 times the land area of the UK, but only 4 times the population. That is a very difficult factor to overcome when providing services of this type.

[former player]

Extraordinary sums being charged.  If I'm ever in the US I'll be sure to check my insurance covers air ambulances.  In the UK air ambulances are generally charities, well-coordinated to avoid duplication/provide back-up, and free at the point of use.  A friend of mine had a ride in one a year ago after falling unconscious with a brain bleed (she has recovered excellently) and her walking group has made it their charity this year, but there is no requirement or expectation of payment.  I prefer our system.

Part of the issue is the USA has over 40 times the land area of the UK, but only 4 times the population. That is a very difficult factor to overcome when providing services of this type.

Geographical size has nothing to do with the inefficiencies and profiteering of the USA system.   A rational network of charitable providers or a properly regulated system of private sector providers would both resolve the current problems, as they would enable insurance providers to buy into the system, rather than being at the mercy of the current wild west/robber baron situation.

[Paul der Krake]

It doesn't cost 41k to man a flight for an hour and they know it. This is only their opening hand and they will take the "loss" on their tax returns. Fuck them.

Compute a reasonable helicopter cost, bump it by 50% to account for profit margins and the fact that they saved your life, and offer that along with your reasoning.

[Metric Mouse]

Geographical size has nothing to do with the inefficiencies and profiteering of the USA system.   A rational network of charitable providers or a properly regulated system of private sector providers would both resolve the current problems, as they would enable insurance providers to buy into the system, rather than being at the mercy of the current wild west/robber baron situation.

You are suggesting that people in the USA would have to be more than 10 times as charitable as people in the UK to get the same level of response and service, due to geographic size per population. I'm not sure how you think that is the best, or most reasonable, answer.

[RedwoodDreams]

Wow, I'm glad you're OK.

Agree with other posters about negotiating price down, and I've also learned that hospitals, etc. will let you pay down debt over a long stretch of time at 0% interest. And I mean $50/month for all eternity. :-)  The ones I've negotiated with do this by sending it to "collections," so just know that if you do this, you're locked into the price you've agreed to pay; it becomes non-negotiable (at least in my experience...might depend on the provider).

Though they'll often knock the price down significantly if you pay them off in cash.

Also, remember that you can write off medical costs that are above 10% of AGI, so there could be a significant tax write-off on this as well.

Speedy healing!

[former player]

Geographical size has nothing to do with the inefficiencies and profiteering of the USA system.   A rational network of charitable providers or a properly regulated system of private sector providers would both resolve the current problems, as they would enable insurance providers to buy into the system, rather than being at the mercy of the current wild west/robber baron situation.

You are suggesting that people in the USA would have to be more than 10 times as charitable as people in the UK to get the same level of response and service, due to geographic size per population. I'm not sure how you think that is the best, or most reasonable, answer.

10 times the land area doesn't mean 10 times the cost, because a lot of the costs are fixed and have nothing to do with the ground covered.  10 times the land area also has almost nothing to do with inefficiency, duplication and price gouging either.

But in any case I didn't suggest charity as the only method, proper regulation of the sector could work too.

[Salim]

Sorry to hear about that.  I'm glad you are okay!

I have no advice, unfortunately, but I'm curious now.

Please let us know how this turns out.

Thank you, I will let you know.

[debbie does duncan]

I am glad you are Ok now.
I am in Canada , B.C.
Our provincial rules are you pay for the first ambulance ride..the second is on the province.
The first ride for my husband was $50....as it was land. The second was air from Victoria to Vancouver.
 Short ride but the clock starts ticking when the helicopter lifts off.
Glad I did not even see that bill.
Check and read all the paperwork .
Your state may have rules you can bend or negotiate.
Good Luck

[Spork]

It doesn't cost 41k to man a flight for an hour and they know it. This is only their opening hand and they will take the "loss" on their tax returns. Fuck them.

Compute a reasonable helicopter cost, bump it by 50% to account for profit margins and the fact that they saved your life, and offer that along with your reasoning.

I've got no real clue what it really costs... just thinking aloud here and trying to toss generous margins in there.

I believe a Bell Jetranger costs about $500/hr to operate.  Double that and call it $1000.  Outfit it with medical equipment... I dunno, let's double it twice again and call it $4000/hr. 

Add a crew of 3 highly qualified professionals that have to be paid 24x7...  My wild ass calculations tell me it takes about 4.2 people to staff each position to work 40 hour weeks for 24x365, so that is about 12.5 people to staff 3 positions.  Let's pay them $100k a year, so there is $1.2M in salary (not counting benefits).... That comes out to $143/hr.  Round it up add into the above and we get $4200/hr.

The cost for the crew is for the hour of use... but somehow you have to share the cost of the downtime across all the flights.  I have no idea how much uptime/downtime they have.  Let's double it again for grins. and we're at $8k and change. 

I'll wildly guess if you round it up to $10k ... you're covering everything... I'd wildly offer them $10k, take it or leave it and see what they say.  It would be interesting to know what an insurance company negotiated cost is for this.  And maybe that wouldn't be that hard to get.

[I'm a red panda]

Doesnt your policy have an out of pocket maximum?  Or is it that the air ambulance comany was not in network or the bill not counted toward your out of pocket max?

Out of network companies can balance bill. So even if it does count towards an out of pocket max (my insurance has seperate in-network and out-of-network out of pocket maxes) out of pocket max is kind of a misnomer. It's out of pocket max of allowable, covered charges. Not the maximum you actually have to pay.  I found this out last year, though only to the tune of about $15k.

OP- First, I'd appeal to your insurance to try to get higher coverage. A lot of times if there is no in-network option your insurance covers you more than they would have if you selected an out of network on purpose.  If it was life saving care, you can sometimes get more coverage. If you feel they used too low of allowable charges, you can get more coverage.  Appealing can take a lot of effort. In the case I described above, I ate the $15k after one appeal because I didn't have the energy to keep fighting; but your bill is much higher.

Second- start negotiating with the air ambulance. They may lower the charge. They may accept $20 a month for the rest of your life (and then eat the balance at the end, as presumably you won't live another 175 years...)  In my case, neither was possible- I actually had to pay upfront for my care, so the money was already gone.

Third- Medical bankruptcy?  You'd need to do a lot of research how this affects all your other holdings. I'd avoid this at all costs, personally.

I don't know what you can truly afford to cover, as your bill was quite a bit higher than mine; but in the end, we just decided to be grateful we were in a position where it didn't set us back horribly to be able to pay it and we didn't need to file bankruptcy.

[Salim]

Thanks for all the good suggestions about approaching the insurer and provider. The systems in other countries make me jealous! There is also another approach out west in the USA. My sister who lives on the west coast said she gets ads from the air ambulance companies about buying insurance from them. With low cost insurance from them, flights when needed are very inexpensive or free. Does that mean (once again) the well to do states are subsidising the poorer states?

To answer your questions:
We will not use bankruptcy and we will negotiate.
I read the air ambulance company reported their cost is about $10,000 per flight.

We called Blue Cross today. The rep said they have already paid the air ambulance company, and the company has already cashed the check (for about $3,700). She said the provider is not allowed to "balance bill" (which means bill us for the balance) and we should call BC if we do receive an invoice. I'll be delighted if that's the end of it, but not surprised if it's not. I'll let you know about what happens.

Meanwhile, the important thing I want to share is that I received an invoice from the air ambulance company before any paperwork from Blue Cross. The invoice, for the full amount (over $41K), was marked "Urgent Action Required". I also received a form, "Assignment of Benefits, Required for Insurance Billing". This form is a contract, requiring my signature, that says I would accept responsibility for any unpaid charges and any attorney fees incurred by the provider.

Even though the contract says it is required for insurance billing, the provider, according to BC, did bill BC directly without a signed contract from me. It was a ruse! (And it feels like kicking me when I was down.) If I had signed and returned the contract, I would have become legally responsible for the full bill. So, if you should find yourself in a similar situation, it might be wise to pause, read the fine print, and avoid signing anything until you get some more information.           

[I'm a red panda]

We called Blue Cross today. The rep said they have already paid the air ambulance company, and the company has already cashed the check (for about $3,700). She said the provider is not allowed to "balance bill" (which means bill us for the balance) and we should call BC if we do receive an invoice. I'll be delighted if that's the end of it, but not surprised if it's not. I'll let you know about what happens.
     

This would really be best case scenario. If they have a contract with BC, and they aren't supposed to be balance billing; it will be BC who goes after them for breach of contract; not you!

[Salim]

This would really be best case scenario. If they have a contract with BC, and they aren't supposed to be balance billing; it will be BC who goes after them for breach of contract; not you!

That would be great!

[Mr. Green]

Even though the contract says it is required for insurance billing, the provider, according to BC, did bill BC directly without a signed contract from me. It was a ruse! (And it feels like kicking me when I was down.) If I had signed and returned the contract, I would have become legally responsible for the full bill. So, if you should find yourself in a similar situation, it might be wise to pause, read the fine print, and avoid signing anything until you get some more information.         

Super shady! Sad...

[HenryDavid]

A friend of ours, who happens to be from BC, had a life-threatening stroke in rural France--a Socialist country.
A nurse neighbour called the equivalent of EMS, a chopper quickly landed at the edge of town, and he was in a hospital bed in 45 mins.
No long-term damage form the stroke.
Cost covered by Socialist health care, for which our friend had been paying the low monthly premiums since moving to France full time.
Single-payer socialized medical care. A public good which market-based systems can't really compete with, it seems.

[Reynold]

A fairly large helicopter in my neck of the woods runs about $7,000/hr to contract - that includes fuel, crew, chopper, insurance, you name it.

Did you ever try to contract them for one hour, as opposed to half a day or a day, on 10 minutes notice?  What do you think they would have to charge if they had to be available on that kind of notice, 24/7, and had maybe 5 hours of work a week? 

Anyway, OP, it is indeed good that you read that contract and did not just sign and return it.  My DW and I have more than once read contracts in doctor's offices and other places and struck out lines, written things in, and initialed them before signing.  It is rare that the office staff has an issue with it, I suspect having that happen is so rare that they don't have a policy in place.  :)

[Metric Mouse]

Even though the contract says it is required for insurance billing, the provider, according to BC, did bill BC directly without a signed contract from me. It was a ruse! (And it feels like kicking me when I was down.) If I had signed and returned the contract, I would have become legally responsible for the full bill. So, if you should find yourself in a similar situation, it might be wise to pause, read the fine print, and avoid signing anything until you get some more information.         

Super shady! Sad...

Right? We're all rooting for you Mara!

[marty998]

Even though the contract says it is required for insurance billing, the provider, according to BC, did bill BC directly without a signed contract from me. It was a ruse! (And it feels like kicking me when I was down.) If I had signed and returned the contract, I would have become legally responsible for the full bill. So, if you should find yourself in a similar situation, it might be wise to pause, read the fine print, and avoid signing anything until you get some more information.         

Super shady! Sad...

This is utterly disgusting. Shameful behaviour from the provider.

Your healthcare system is broken.

[Salim]

A friend of ours, who happens to be from BC, had a life-threatening stroke in rural France--a Socialist country.
A nurse neighbour called the equivalent of EMS, a chopper quickly landed at the edge of town, and he was in a hospital bed in 45 mins.
No long-term damage form the stroke.
Cost covered by Socialist health care, for which our friend had been paying the low monthly premiums since moving to France full time.
Single-payer socialized medical care. A public good which market-based systems can't really compete with, it seems.

Hm, if the BC payment does take care of the bill, the end result is not unlike your description of Socialist health care... because I was fortunate to be on Medicare, which has a lower monthly rate for insurance, and I got excellent care after the accident.

[Villanelle]

It doesn't cost 41k to man a flight for an hour and they know it. This is only their opening hand and they will take the "loss" on their tax returns. Fuck them.

Compute a reasonable helicopter cost, bump it by 50% to account for profit margins and the fact that they saved your life, and offer that along with your reasoning.

yes and no.  Helicopters are damn expensive to operate and maintain.  You aren't just paying for the hour (or 20 minutes) you are in the helicopter.  You are paying for part of the costs associated with keeping pilots on call and with maintaining that aircraft.  Then you have the medical professionals who are on call in addition to the pilots, the medical equipment and certifications, etc.

$40k is a lot, but I suspect it isn't *quite* as ridiculous as it seems. 

[Salim]

A fairly large helicopter in my neck of the woods runs about $7,000/hr to contract - that includes fuel, crew, chopper, insurance, you name it.

Did you ever try to contract them for one hour, as opposed to half a day or a day, on 10 minutes notice?  What do you think they would have to charge if they had to be available on that kind of notice, 24/7, and had maybe 5 hours of work a week? 

Anyway, OP, it is indeed good that you read that contract and did not just sign and return it.  My DW and I have more than once read contracts in doctor's offices and other places and struck out lines, written things in, and initialed them before signing.  It is rare that the office staff has an issue with it, I suspect having that happen is so rare that they don't have a policy in place.  :)

SnackDog, regarding fair rates, in this case, I don't know what would have happened if we had known what the flight might cost. The situation was out of our hands and authority figures were calling the shots. That's why we have insurance.

Insurance appears to be a complex business. Do the providers get by because of volume? Perhaps the hospital that sponsors the air ambulances helps support them, too. Providers can claim losses and they must have insurance, too. Even insurance companies have re-insurance for their own claims.

I know what you mean about the things we have to sign in the doctors' offices! So much is about protecting the bottom line. I feel lucky to have found a good PCP who takes Medicare and is also very nice.

[Salim]

Right? We're all rooting for you Mara!

Thanks! I really appreciate the information and support from everyone.

I'm back at my desk (at home) working a few hours a day. Yesterday, I went outside for a few minutes and gave my horse some hay for lunch. It's wonderful to be able to breathe freely and move around more, things we usually take for granted...

[I'm a red panda]

I'm back at my desk (at home) working a few hours a day. Yesterday, I went outside for a few minutes and gave my horse some hay for lunch. It's wonderful to be able to breathe freely and move around more, things we usually take for granted...

That's wonderful progress! 

[Paul der Krake]

It doesn't cost 41k to man a flight for an hour and they know it. This is only their opening hand and they will take the "loss" on their tax returns. Fuck them.

Compute a reasonable helicopter cost, bump it by 50% to account for profit margins and the fact that they saved your life, and offer that along with your reasoning.

yes and no.  Helicopters are damn expensive to operate and maintain.  You aren't just paying for the hour (or 20 minutes) you are in the helicopter.  You are paying for part of the costs associated with keeping pilots on call and with maintaining that aircraft.  Then you have the medical professionals who are on call in addition to the pilots, the medical equipment and certifications, etc.

$40k is a lot, but I suspect it isn't *quite* as ridiculous as it seems.

No, that's still bullshit.

Even if they only respond to 2 calls per day (at which point they probably shouldn't be in business), that's still 3 million in revenue per year. It doesn't cost 3 million per year to run a helicopter and have pilots and medical professionals on call. This article pegs the number at 1m per year to operate.

http://www.emsworld.com/article/10325077/ems-myth-6-air-medical-helicopters-save-lives-and-are-cost-effective

This is the same bullshit that makes it that broken arm costs $5,000 in the ER to an uninsured person, or monthly insurance premiums in the 4 digits.

Burn this whole thing to the ground.

[NoStacheOhio]

Insurance appears to be a complex business. Do the providers get by because of volume? Perhaps the hospital that sponsors the air ambulances helps support them, too. Providers can claim losses and they must have insurance, too. Even insurance companies have re-insurance for their own claims.

I know what you mean about the things we have to sign in the doctors' offices! So much is about protecting the bottom line. I feel lucky to have found a good PCP who takes Medicare and is also very nice.

I don't know the specifics of the service that did your transport, but I can tell you how ours works. We're a major health system with pretty extensive ground and air transport operations.

The medical providers (EMT-P, CNP, MD/DO) are mostly regular (W-2) employees of our health system. There are a handful of EMTs who work for our ground contractor. The same people may provide care in a ground ambulance, helicopter or jet.

We contract for flight services with two different companies (one for fixed-wing, one for helicopter). They provide the aircraft and the pilots. Services are billed in two separate parts, one for medical care and one for transport. The transport side gets ugly sometimes, and I know charges and collection practices have previously been a point of contention between us and our previous flight vendor. I don't know if it's gotten any better in recent years.

Independent operators may use a similar model where medical and flight crews are separate entities. I know from risk management standpoint, they want the pilots secluded from the medical side. They don't want the pilots making bad go/no go decisions based on medical reasons.

[Salim]

I'm back at my desk (at home) working a few hours a day. Yesterday, I went outside for a few minutes and gave my horse some hay for lunch. It's wonderful to be able to breathe freely and move around more, things we usually take for granted...

That's wonderful progress!

Thank you!

[Salim]

I don't know the specifics of the service that did your transport, but I can tell you how ours works. We're a major health system with pretty extensive ground and air transport operations.

The medical providers (EMT-P, CNP, MD/DO) are mostly regular (W-2) employees of our health system. There are a handful of EMTs who work for our ground contractor. The same people may provide care in a ground ambulance, helicopter or jet.

We contract for flight services with two different companies (one for fixed-wing, one for helicopter). They provide the aircraft and the pilots. Services are billed in two separate parts, one for medical care and one for transport. The transport side gets ugly sometimes, and I know charges and collection practices have previously been a point of contention between us and our previous flight vendor. I don't know if it's gotten any better in recent years.

Independent operators may use a similar model where medical and flight crews are separate entities. I know from risk management standpoint, they want the pilots secluded from the medical side. They don't want the pilots making bad go/no go decisions based on medical reasons.

Thanks for providing more insight into the system. From the article Paul linked, it looks like the flight services industry is still evolving and has a way to go.

[NoStacheOhio]

I don't know the specifics of the service that did your transport, but I can tell you how ours works. We're a major health system with pretty extensive ground and air transport operations.

The medical providers (EMT-P, CNP, MD/DO) are mostly regular (W-2) employees of our health system. There are a handful of EMTs who work for our ground contractor. The same people may provide care in a ground ambulance, helicopter or jet.

We contract for flight services with two different companies (one for fixed-wing, one for helicopter). They provide the aircraft and the pilots. Services are billed in two separate parts, one for medical care and one for transport. The transport side gets ugly sometimes, and I know charges and collection practices have previously been a point of contention between us and our previous flight vendor. I don't know if it's gotten any better in recent years.

Independent operators may use a similar model where medical and flight crews are separate entities. I know from risk management standpoint, they want the pilots secluded from the medical side. They don't want the pilots making bad go/no go decisions based on medical reasons.

Thanks for providing more insight into the system. From the article Paul linked, it looks like the flight services industry is still evolving and has a way to go.

Agreed. I've heard some of our people literally refer to an independent outfit as "pirates." Landing without clearance and all sorts of shenanigans.

[Salim]

$40k is a lot, but I suspect it isn't *quite* as ridiculous as it seems.

No, that's still bullshit.

Even if they only respond to 2 calls per day (at which point they probably shouldn't be in business), that's still 3 million in revenue per year. It doesn't cost 3 million per year to run a helicopter and have pilots and medical professionals on call. This article pegs the number at 1m per year to operate.

http://www.emsworld.com/article/10325077/ems-myth-6-air-medical-helicopters-save-lives-and-are-cost-effective

This is the same bullshit that makes it that broken arm costs $5,000 in the ER to an uninsured person, or monthly insurance premiums in the 4 digits.

Burn this whole thing to the ground.

Interesting article, Paul. Thanks for the info.

I'm sure the helicopters, medical teams, and support staff are very expensive to run and I hope the system will evolve and improve.

[Spork]

One more thing of note for the cost.  (I'm not trying to justify the $40k... just tossing some additional info out there).

EMS helicopters are somewhat of a risky operation.  They are more likely to be operating in bad weather (more auto accidents at that time) and they generally land at unimproved areas.  They cannot very well do an ILS approach at the scene of an auto crash.  Instead they have to skim under and around the clouds and visually locate obstacles (trees, power lines, etc) in low visual conditions.  There is a pretty high rate of fatalities amongst EMS ambulance crews.

I suspect this adds to the cost.  More risk means higher insurance costs for them, higher salaries for the employees, higher (or more often) replacement costs for helicopters, etc.

[Villanelle]

It doesn't cost 41k to man a flight for an hour and they know it. This is only their opening hand and they will take the "loss" on their tax returns. Fuck them.

Compute a reasonable helicopter cost, bump it by 50% to account for profit margins and the fact that they saved your life, and offer that along with your reasoning.

yes and no.  Helicopters are damn expensive to operate and maintain.  You aren't just paying for the hour (or 20 minutes) you are in the helicopter.  You are paying for part of the costs associated with keeping pilots on call and with maintaining that aircraft.  Then you have the medical professionals who are on call in addition to the pilots, the medical equipment and certifications, etc.

$40k is a lot, but I suspect it isn't *quite* as ridiculous as it seems.

No, that's still bullshit.

Even if they only respond to 2 calls per day (at which point they probably shouldn't be in business), that's still 3 million in revenue per year. It doesn't cost 3 million per year to run a helicopter and have pilots and medical professionals on call. This article pegs the number at 1m per year to operate.

http://www.emsworld.com/article/10325077/ems-myth-6-air-medical-helicopters-save-lives-and-are-cost-effective

This is the same bullshit that makes it that broken arm costs $5,000 in the ER to an uninsured person, or monthly insurance premiums in the 4 digits.

Burn this whole thing to the ground.

That article pegs it as $1mm.yr to operate, plus ~$1.5-5.7mm to purchase.  And it's not clear it that also includes the medical staff and equipment, and if that is the cost range for all helos, or for larger and medically equipped helos.  Even if it is, and even if we take a medium purchase price of about $3.6m, your numbers are off. 

[Paul der Krake]

It doesn't cost 41k to man a flight for an hour and they know it. This is only their opening hand and they will take the "loss" on their tax returns. Fuck them.

Compute a reasonable helicopter cost, bump it by 50% to account for profit margins and the fact that they saved your life, and offer that along with your reasoning.

yes and no.  Helicopters are damn expensive to operate and maintain.  You aren't just paying for the hour (or 20 minutes) you are in the helicopter.  You are paying for part of the costs associated with keeping pilots on call and with maintaining that aircraft.  Then you have the medical professionals who are on call in addition to the pilots, the medical equipment and certifications, etc.

$40k is a lot, but I suspect it isn't *quite* as ridiculous as it seems.

No, that's still bullshit.

Even if they only respond to 2 calls per day (at which point they probably shouldn't be in business), that's still 3 million in revenue per year. It doesn't cost 3 million per year to run a helicopter and have pilots and medical professionals on call. This article pegs the number at 1m per year to operate.

http://www.emsworld.com/article/10325077/ems-myth-6-air-medical-helicopters-save-lives-and-are-cost-effective

This is the same bullshit that makes it that broken arm costs $5,000 in the ER to an uninsured person, or monthly insurance premiums in the 4 digits.

Burn this whole thing to the ground.

That article pegs it as $1mm.yr to operate, plus ~$1.5-5.7mm to purchase.  And it's not clear it that also includes the medical staff and equipment, and if that is the cost range for all helos, or for larger and medically equipped helos.  Even if it is, and even if we take a medium purchase price of about $3.6m, your numbers are off. 

You're right- my math is off. There is a zero missing. It's 30 million in revenue.

[nnls]

Geographical size has nothing to do with the inefficiencies and profiteering of the USA system.   A rational network of charitable providers or a properly regulated system of private sector providers would both resolve the current problems, as they would enable insurance providers to buy into the system, rather than being at the mercy of the current wild west/robber baron situation.

You are suggesting that people in the USA would have to be more than 10 times as charitable as people in the UK to get the same level of response and service, due to geographic size per population. I'm not sure how you think that is the best, or most reasonable, answer.

10 times the land area doesn't mean 10 times the cost, because a lot of the costs are fixed and have nothing to do with the ground covered.  10 times the land area also has almost nothing to do with inefficiency, duplication and price gouging either.

But in any case I didn't suggest charity as the only method, proper regulation of the sector could work too.

Australia has a similar land size to the USA and less than a 10th of the population, we also have charitable providers of these kinds of services. It certainly wouldn't cost anywhere near this price. 

[Metric Mouse]

Australia has a similar land size to the USA and less than a 10th of the population, we also have charitable providers of these kinds of services. It certainly wouldn't cost anywhere near this price.

A cursory reading online suggests that this is not fully correct; many of the air crews in Australia are funded or partially staffed/supplied by government agencies. There are some large-scale not-for-profit companies that provide these services in areas as well, but the system appears to be a mix of this and government funded.

This model could work; it certainly makes more sense than a wholly charitable one.

[FIREby35]

Im on vacation so answer will be short - first if accdent was not your fault you should get an attorney. A personal injuty attorney will help with this issue. I have fought Rocky Mountain holdings multiple times on behalf of injured clients and never paid anywhere near the full price. Ever.

Even if you dont have a personal injury claim, you could look for a good injury attorney in your area to help with the negotiations. If they are good they can negotiate from a much stronger position thsn you can. They could charge you by thr hour. 41k buys a lot morr attorney time than helicopter time. !aybe we can start making EMT jokes instead of lawyer jokes.... :)

Right now you need to focus on your health. Look for a professional to take this off your plate. If the attorney is good, it will save you tens of thousands of dollars of the billed amount.

PM if you want any additional info.

[Playing with Fire UK]

Geographical size has nothing to do with the inefficiencies and profiteering of the USA system.   A rational network of charitable providers or a properly regulated system of private sector providers would both resolve the current problems, as they would enable insurance providers to buy into the system, rather than being at the mercy of the current wild west/robber baron situation.

You are suggesting that people in the USA would have to be more than 10 times as charitable as people in the UK to get the same level of response and service, due to geographic size per population. I'm not sure how you think that is the best, or most reasonable, answer.

10 times the land area doesn't mean 10 times the cost, because a lot of the costs are fixed and have nothing to do with the ground covered.  10 times the land area also has almost nothing to do with inefficiency, duplication and price gouging either.

But in any case I didn't suggest charity as the only method, proper regulation of the sector could work too.

Australia has a similar land size to the USA and less than a 10th of the population, we also have charitable providers of these kinds of services. It certainly wouldn't cost anywhere near this price.

Yes, the difference is the amount of regulation or inclination to avoid price-gouging. It can be done for charity, by the state or by private companies within a framework. If there is nothing to stop air ambulances price gouging then they will use any excuses for raising prices.