published Monday, February 17th, 2014

E.R. in the sky

Those life-saving airlifts don’t come cheap, but now there’s a new way to pay for them

A Life Force helicopter lands at Erlanger Hospital.
A Life Force helicopter lands at Erlanger Hospital.
Photo by C. B. Schmelter.
HOW MANY FLIGHTS?

Bledsoe County: 164 medical flights in two years

Sequatchie County: 227 flights in 45 months

Marion County: 117 flights in 45 months

Source: LifeForce

The journey from rural Bledsoe County to the trauma center in Chattanooga can be an hour-plus ambulance ride over mountainous terrain.

Or it can be a 15-minute ride in a medical helicopter.

Last year, Erlanger’s LifeForce helicopter airlifted 84 patients from Bledsoe County to the hospital. The year before, there were 80 such cases.

That’s why county Mayor Bobby Collier and county commissioners say $43,500 is a small price to pay for coverage they say will help Bledsoe’s 12,800 residents avoid sky-high bills when their lives are on the line.

“Some who work in agriculture may be faced with a career-changing decision to pay a medical bill after something like this,” the mayor said. “Our thought was, ‘Let’s do something for the people in our county who can help take care of it.’”

Last fall, the county jumped into a relatively new concept: Air ambulance coverage for everyone.

After Bledsoe leaders voted unanimously to purchase the coverage in October, the Marion County town of Kimball followed suit. The annual premium for Kimball’s 1,300 residents was $9,750. For someone without insurance, a single helicopter flight could be nearly three times that.

“I think this is a good thing for our citizens,” Kimball Mayor David Jackson told the Times Free Press in December. “I hope they never have to use it, but it’s there if we need it.”

Bledsoe was the first county in Southeast Tennessee to purchase its citizens a group membership plan with AirMedCare network. The national air medical care company’s Med-Trans subsidiary operates Chattanooga-based LifeForce.

AirMedCare officials emphasize the plan is not insurance — it does not include deductibles or co-pays — but it functions similarly.

For network members, all costs for a medical airlift not covered by their insurance are defrayed, said Jimmy Morse, a membership sales manager with AirMedCare who is based with LifeForce in Chattanooga. Uninsured members will face much lower bills than they would without the coverage, he said.

Such plans typically have been targeted to individuals or businesses. Some governments, including McMinn and Polk counties, have purchased it for their employees.

But last year, Morse, whose area includes Southeast Tennessee and North Georgia, began approaching city and county governments about covering all of their residents with a membership package called a “municipal slate plan.”

Morse said he’s been reaching out mostly to rural communities, such as Marion and Sequatchie.

“This kind of coverage especially makes sense in the Sequatchie Valley, because it is just so mountainous,” he said.

When pitching the plan to community leaders, he shows them the number of flights in their areas and the cost of a service that many don’t even question in the midst of a life-threatening emergency.

There is what’s called a “golden hour” after an accident or a medical event like a stroke that’s crucial for a patient’s survival and recovery, said Stacey Prater, a flight paramedic with Erlanger Health System who flies with LifeForce.

“The golden hour starts at the time the accident occurs, and you want to have them in the facility where you can perform surgical intervention within the hour,” Prater said. “When you’re in a remote county like Bledsoe, you’ve got that hour drive, but you’ve also got the time you need to extract them from an accident.”

But a quick trip within that golden hour can come at a hefty price.

The average bill for a medical air flight is now $25,000, according to AirMedCare figures. Morse said the huge price tag is because the helicopter essentially is an emergency room in the air. On top of fuel, aviation equipment and piloting costs, there are high costs for complex medical machinery and specialized flight medics.

Insurance may pay part of the bill, but coverage varies greatly from plan to plan. That’s where the AirMedCare membership would kick in.

“With the membership, someone who is flown will not get that out-of-pocket bill,” Morse said.

In Bledsoe, coverage is limited to accidents or medical events inside the county unless residents sign up for a $35 upgrade that covers them within AirMedCare’s 28-state network, which includes Tennessee, Georgia and Alabama.

Members without insurance will be billed the Medicare allowable rate, estimated at around $4,000. The $35 upgrade provides full coverage.

An algorithm determines how much a municipal coverage plan will cost. Factors include population, percentage of insured and uninsured, and number of people on federal health insurance programs — Medicaid and Medicare patients are not eligible for membership.

Such memberships are not regulated by state law, said Kate Abernathy, spokeswoman for the Tennessee Department of Commerce and Insurance.

“Our main interaction is with insurers who cover the [helicopter transport] in their policies and not the [transport] company itself,” Abernathy said. “We would regulate the policies to the extent that their language speaks to transportation via helicopter. We don’t regulate the subscription contracts.”

The concept was a new one for Russ Blakely, a Chattanooga insurance broker who consults with several large groups, including Hamilton County government, about employee benefits.

“I’ve never encountered a city or a county that took on that kind of obligation to cover all of its citizens with a benefit like this,” Blakely said.

“[Medical airlifts] are such an anomaly, I’m not sure I would ever advise an employer to offer it to their employees. It is far too rare,” he said.

“I guess Bledsoe is in a different situation because all its citizens face the potential need to be airlifted if they have a serious accident or something like a stroke. … Still, if I were a taxpayer there I would be asking questions.”

Collier said the money for Bledsoe’s plan came from its emergency services fund and did not require a tax increase.

“I’m sure there’s critics; there always are,” said Collier. “Many folks said was it too good to be true — you saw the wheels turning in their heads. But the biggest response by far is that this is one of the best things we’ve done for the working people, because it gives them access to this service in a realistic way.”

Collier and Morse say the plan has already proven its worth. At least 34 people have been flown out of the county since the membership started.

The day after the agreement was signed, a young man crashed his motorcycle and had to be flown out. Two weeks after that, a child fell on the playground at school. He lost pulse in his shattered arm and needed a fast flight to the hospital.

“We may have been an experiment,” Collier said. “But it definitely has seemed like too good of an opportunity to pass up.”

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