The ones who truly aren't going to pay won't qualify for the "finance company". That person is also more likely to be the person who didn't buy a membership. (Although people who in general didn't approve of Air Evac coming to Rushville also would be less likely to have a membership so that's an added twist...)

[/QUOTE]

SALTY WROTE...

You missed my point. If say, it were me- a citizen who does not have a 'membership', if I accept a flight and my insurance does not cover it, then the company will finance the entire bill for me. Then, if I don't/can't pay, the finance company sues me and garnishes my wages and such. The finance company does not care whether or not the flight was medically necessary- they have a note and they intend to enforce it.

In this way, the hospital or flight company still gets their money, even if it was not a medically necessary transport.

Tis is the 'loophole of billing' i've been referring to.


Well, I'd say it's free enterprise and a two way street. You have the right on the other hand to contest the flight and prove that air medical transport was not justified.

However, I'd again like to point out that air medical flights are by and large based on medical necessity. Your question was pivoting on the possibility that there are a large number of medically unnecessary flights. There are not in the State of Indiana or in the midwest as a region in general.

I don't know what percentage of a bill an air medical provider might be willing to write off, however, I am sure they are not charging interest. Air medical providers are not finance companies.

I don't subscribe to the hell bent on collection angle...it's a PR nightmare having a company calling up and threatening now-discharged long term trauma patients. If you're a third-party air medical provider providing services to that health care system, it's a sure ticket for early contract termination.

Medical collections are a way of life in America. This is a sore subject with me. Medical bills just don't appear...they are generated. Even when you have insurance, medical care remains one of the last blank check/honor pay systems and plays into the cost of doing business for health care systems and physicians.

By the same token, I'll agree that no one should be unnecessarily or wrongly saddled with such a financial burden.

Consider this: a serious car accident can land you in the hospital at a level I trauma center for 10 days, plus outpatient rehab/therapy for eight weeks at a total cost of $225,000 (that's a round guess). All things considered, are you really going to get bent out of shape over the $8,500.00 (another round guess) the initial air medical transport costs?

While perceptions of money among all of us may vary widely, I'm sure everyone will agree it's not an unreasonable charge.

T.B.,

There are rumors that some of the financial arrangements between RMH and Air Evac is based on Medicaid and Medicare patients. I am not sure how the government would reimburse for air flights, and I hope they would be tight when it came to paying for air transport, but since Wishard is a County operated Level 1 Trauma Center, could there be a connection between that and Medicaid transports?

You do seem well informed on this, and I hope you do not mind if I pick your brain some more. How safe are the repurposed helicopters that Air Evac uses? I am told they are helicopters that were used for transport to oil wells and such in the Gulf and how do they compare to purpose built medical transports such as Lifeline for patient care. I had one person crudely compare Air Evac copters to the old station wagon type ambulances and the Lifeline type are like the advanced life support modern ambulances. Is this an exageration?

Thanks for your input.

quote:

Originally posted by Rush County Mom:
The ones who truly aren't going to pay won't qualify for the "finance company". That person is also more likely to be the person who didn't buy a membership. (Although people who in general didn't approve of Air Evac coming to Rushville also would be less likely to have a membership so that's an added twist...)

Thank you RCM. I agree 100%. Don't get me wrong their are plenty of good people that will pay off the bill, but their are some that will not for whatever reasons. The percentage of those who won't more than likely either don't work or they are paid in cash so they can't be garnished. I've been working in medical billing for a long time and I've seen it over and over again.

quote:

Originally posted by T.B., FP-C:

While perceptions of money among all of us may vary widely, I'm sure everyone will agree it's not an unreasonable charge.

I would agree it is not an unreasonable charge considering the care you receive. Particularly if it is a life or death situation, which, I would imagine, most such flights are. Or at least that is the perception of the doctor when the air medical service is called.

I personally know of people whose family members were sent to another hospital by an air medical service (Air Evac or otherwise) only to find out that it may not have been necessary because the family member turned out to not be as bad as the tests initially indicated. Do you know what their response to that situation was? "Thank Heaven!" "Praise God!" or any of a number of similar responses. I think that if one of my children were lifelined and I found out later that what showed on the initial test was proved to be wrong, I'd say the same thing. I would be thankful that the hospital and doctors took the extra precaution to get my child the best care possible and I would also be doubly thankful that they were, in fact, wrong and my child was going to be o.k.

Well Mom, unfortunately, that is exactly how many are gouged financially in the healthcare setting.
An overly cautious medical team plus a worried family member equals excessive services. I see it almost every day!
I myself was gouged over a simple broken arm [yes, I seen the x-ray] because the wife was made to worry that if we did not follow thru with a dr's referal to an expensive bone guy we might be 'reported to someone'. I made note of the idea that a simple, non-displaced 'break', or straight crack on a bone did not require anything more than diligent use of a splint for a month or so, and pain meds to get thru a few days, with a follow up x-ray in a few weeks to assure no advancement of the crack.
We were pressured into weekly visits followed by bi-weekly visits, with numurous xrays, and a 'recasting or two'. This resulted in a rather large bill, much of witch was rejected by insurance as beyond necessary or customary.
I'm just glad there was no chopper back then- we'd have probably been air-lifted to an even more expensive bone guy!!!
By the way, despite my reluctance, I paid in full...
Anyhow, I guess my point is, a family's concern or worry, or one dr's fear of lawsuits, is not justification for over treatment and billing. And, again, yes, I see this happen often.

Addendum:
Now, before y'all go off accusin poor ol' uncle Salty of abuse or neglect of his kids, let me state this.
I am willing to pay for what is actually necessary- I'm not a TOTAL CHEAPSKATE. I just don't agree with much of the 'establishment' on what is necessary. And yes, I do know how to read a simple x-ray, and treat SIMPLE fractures and such.
When my jeep is ailing, I don't send it to Germany for Daimler/Chrysler to fix. I either do it myself, or go to the full service local guy. Same for my kids', and my own tired ol' body.

This message has been edited. Last edited by: Uncle Salty,

Salty,

I figured you'd have got out a 2x4 and set that arm yourself!

I think we've all been burnt a time or two on the old "usual and customary" charges. Heck, my insurance one time told me that the charges for anesthesia were beyond the usual and customary. I don't know what they based it on, but I paid the difference. Believe me I wasn't about to argue whether I really needed to be put under for that abdominal surgery just as I was about to be cut open.....

You know, it's always easier to look back on a situation and say, "they did too much." I once thought I broke an arm and the doctor didn't know for sure whether it was broken or not so they did an x-ray. It turned out it wasn't broken. Should I have been ticked because it wasn't broken and I had to pay for an x-ray?

Honestly, the problems you are describing are the types of problems I blame on our over-litigious society. The doctors are overly cautious because of potential lawsuits if they aren't. I think doctors always think it's better to be safe than sorry when it comes to their diagnosis. And you're right when you say that the final outcome is that more people are stuck with big hospital bills. The problem is that until the legal system changes, the medical community is not likely to change either.

You know another problem is that fact that so many docs are specialized anymore. Remember the good old days when you had one doctor. He took care of everything. There was none of this sending patients off to the ENT doctor or the neurologist or the gastroenterologist, etc. One guy, one bill. And he usually gave you a "prescription" for an ice cream from the Rushville Pharmacy if you were really good....

quote:

Originally posted by rushboy:
T.B.,

There are rumors that some of the financial arrangements between RMH and Air Evac is based on Medicaid and Medicare patients. I am not sure how the government would reimburse for air flights, and I hope they would be tight when it came to paying for air transport, but since Wishard is a County operated Level 1 Trauma Center, could there be a connection between that and Medicaid transports?

You do seem well informed on this, and I hope you do not mind if I pick your brain some more. How safe are the repurposed helicopters that Air Evac uses? I am told they are helicopters that were used for transport to oil wells and such in the Gulf and how do they compare to purpose built medical transports such as Lifeline for patient care. I had one person crudely compare Air Evac copters to the old station wagon type ambulances and the Lifeline type are like the advanced life support modern ambulances. Is this an exageration?

Thanks for your input.

In answer to statement number one, they are just rumors without a copy of the actual RMH/AEL agreement, and good luck on getting that.

The government does pay well, and reimbursement is pretty good there in Indiana...that's why so many air medical vendors without a home affiliation in Indiana have set up shop in Hoosierland. There's $$$ to be made.

My bigger beef with AEL and Wishard's past relationship is that I have come to understand that Wishard is a publicly funded hospital (Marion County tax dollars). I'm sure Wishard was paying AEL money to sit there, I don't care what anyone claims/tells you otherwise.

Why? Well...

How many flights did AEL 76 fly within Marion County to serve Marion County residents/taxpayers in all the months it sat there? I'd love to see the numbers on that statistic. I betcha it hovers right around zero.

Alrighty then. In answer to question number two about AEL's use of refurbished Bell 206's versus other medical helicopters, that is correct.

The Bell 206 is used by just a handful of EMS air medical providers in the US. It is a rugged, dependable aircraft which has been produced in enormous numbers, but was never designed or intended for the EMS mission. It is often utilized by programs where cost is an issue. They are cheap to operate.

To answer your question specifically, Lifeline and Univ Cincinnati Aircare operate Messerschmitt MBB BK117 aircraft, which have other variants including Kawasaki and American Eurocopter. It was specifically designed for the tremendous demands of EMS helicopter operations. It is a twin jet engine (700 horsepower each) platform which loads the patient on a stretcher through the backdoors, which open up like "clam shells". The BK 117 can lift heavy loads, has an extended range, greater speed, autopilot capability, AND CAN ALSO FLY ON ONLY ONE ENGINE. Wow.

OK, it's also true that Air Evac Lifeteam buys ancient Bell 206 aircraft that are not only OLD because they were built decades ago but have airframes with 20,000 or more flying hours on them. A lot of these Bell 206 aircraft are old oil platform shuttle aircraft and have been exposed to the salty gulf air for extended period of time. As a result, some have a few corrosion issues I've heard.

AEL just trumpeted last year that they are "upgrading their fleet" with new Rolls Royce engines. More powerful? Yes. Adequate for EMS operations on the whole with three crew members, a full load of fuel, medical equipment plus a 400 pound patient? Not always.

Stories of AEL aircraft getting a 'running start' across the landscape to gain enough airspeed for lift, I believe, are not idle gossip.

AEL probably should, at the minimum, upgrade their fleet to Bell 407's. It would cost them a bundle, but improve their mechanical performance capabilities significantly.

One thing is for sure, as long as they maintain their self-proclaimed Wal-Mart mentality: spending the absolute minimum on day-to-day operations while trying to squeeze the maximum profit out of air medical operations everyone remains at risk.

So, fat chance on those 407's. Or any other type of aircraft which is actually suited a little better for EMS operations.

Want an overview of what everyone is using in the USA for air medical operations versus what Air Evac Lifeteam uses? Go to www.alecbuck.com and view all United States EMS Helicopters state by state. Read who the vendors are. LOOK at the aircraft. COMPARE the aircraft to AEL's aircraft.

Ask yourself why virtually no one uses the 206 (the only few programs outside of AEL I can think of off the top of my head are in Alabama, Tennessee and Texas).

There's also another website which is, ironically, partially sponsored by AEL, called Just Helicopters. I find some of the Air Evac Lifeteam related threads on their forums approach the verge of libel and wild fringe speculation. Some of it, my gut tells me is most likely true. You might be able to find some people who are really in the know about AEL there.

I'd characterize myself as a concerned onlooker, and I refuse to participate in Just Helicopters.

quote:

Originally posted by Rush County Mom:
Salty,

I figured you'd have got out a 2x4 and set that arm yourself!

Well, Mom, that's kinda the idea, but i don't have an x-ray machine at home. All we really needed was the pic of the bone to see if there was any displacement or fragmentation. Had there been either of these, a hi-dallar bone guy is certainly in order.
See, if there aint none of the above, all you need is a few cogesics or vicoden, a splint to use diligently, and a 2 or 3 month supply of tequila!

I've been away for a while. What is the status of Air Evac?

From the chopper setting on the pad, it appears the no fly rule has been lifted. Of course you could not tell that by reading the local paper or looking at the Commissioners Minutes, although I was unable to open the Sept. 15 minutes.

Ok, I got the 9/15 minutes open finally, and they say that the Commissioners upon the request of the Hospital/Commissioners attorney (no conflict of interest there) rescinded the no fly letter. Oddly there was no mention of why they lifted it, which makes me feel no safer. Obviously EMA and the BoC had a reason for stopping, but did not post a reason for lifting it. Also oddly, the Republican did not carry any info about the ban being lifted? Strange really, you would think that would be news worthy. I guess the new motto for the Republican should be "All the news we feel you need to hear."

quote:

Originally posted by rushboy:
Ok, I got the 9/15 minutes open finally, and they say that the Commissioners upon the request of the Hospital/Commissioners attorney (no conflict of interest there) rescinded the no fly letter. Oddly there was no mention of why they lifted it, which makes me feel no safer. Obviously EMA and the BoC had a reason for stopping, but did not post a reason for lifting it. Also oddly, the Republican did not carry any info about the ban being lifted? Strange really, you would think that would be news worthy. I guess the new motto for the Republican should be "All the news we feel you need to hear."

I think the more compelling reason is that only the FAA can truly impose a no fly order or ground anyone's air carrier certificate.

I don't believe EMA or BoC have the authority to interfere with whatever agreement exists between AEL and RMH as private entities.

EMA and BoC would have had to show immediate danger to back up their order and make it stick from a federal standpoint. All we really have is a rotorcraft that allegedly had a separation of the main rotor from the mast (insert speculation here and run wild).

I believe AEL knew this and rather than fight the establishment, let the FAA do their heavy lifting. They simply waited for the dust to settle thereafter.

Many people are immensely interested in the investigation. I hope the bloggers here will keep checking for the final report on AEL 76 months down the road from NTSB.

I would think since the hospital is a County owned facility, the Commissioners have the right to order no flights in or out of their facility. I know they hold three seats on the Hospital Board as well.

I think the biggest issue is what would have happened had the rotor separated 1,000' from the hospital. Instead of ripping up a cornfield, there is plenty of places those helicopter parts could have gone. Schools, houses and businesses are all in the area.

I realize that in many cases, helicopters are vital in getting someone to a hospital to save lives. I am good with that. The end does justify the means. What bothers me is the number of flights the helicopter took for P.R. purposes, sight seeing (I talked to several people working in Moscow and they said it flew and circled over the area several times a week for several weeks after the tornado hit) and giving helicopter rides to elected officials (I know one City Councilman who turned down such an offer) and flying a local paper reporter to St. Louis to tour their facilities there.

Everything works on odds, and the more they fly the chopper over populated areas, the better the chance something bad will happen. I still wonder what percentage of their flights out of RMH are actually to pick up a patient and bring them back to RMH for treatment or to take a patient from RMH to another hospital. Otherwise they could have and should have located their base just outside of town where it would affect fewer people.

You may be able to search RMH's financials here
http://www.guidestar.org/
The last 3 reports from RMH are free. A log in is required.
You may also try this link http://www.taxexemptworld.com/organizations/rush-county-in-indiana.asp
There may be some other charity sites that show the Form 990 reports.