Case Managers: What Kind of Air Medical Transport Do You Recommend?
On Tuesday we blogged about how important it is that healthcare providers put aside their own financial interests when advising patients on medical decisions – that they focus exclusive on what is the right outcome for the patient, no matter what.
That post (and this one) was inspired by the story of Charlie Pridmore, who had a stroke while fishing in North Carolina. He was rushed to the “closest accredited stroke center,” Piedmont Medical Center in Rock Hill, by ground ambulance. After doctors there had stabilized him, he spoke to a specialist at Medical University of South Carolina in Charleston who told him that he could “develop what he calls a ‘brain bleed’ and could die if a specially trained neurosurgeon was not on standby to install a stint. She said, ‘I'm the only doctor.’”
So, thinking his life was in the balance, Mr. Pridmore took an air ambulance to Medical University of South Carolina in Charleston. The final transport bill, which the insurance company denied to cover: $58,477.
The story got me thinking about how case managers – who are a crucial interface between the patients and their families and the doctors (and the insurance companies) – work with doctors to determine the right form of medical transport for the patient. (Of course case managers don’t make the decision; the doctor decides where and how the patient is transported, but the case manager is a crucial resource to draw from his/her previous experience, to know what forms of transport are available in the area, and to know the differences between forms of transport and providers.)
In that decision making process, obviously health and safety are the first priorities, but cost matters too – right? You want the least expensive option that will transport your patient safely from one facility to the other.
And that’s exactly the point. I would venture to guess that if an air ambulance transfer to a hospital in another state was the medically necessary option (the patient would have died or suffered long term consequences without it) then:
a) the insurance company might have covered the cost (not always, of course, but insurance companies at the least want proof of medical necessity); and
b) the patient and his family might look on the expense differently. Of course $58,000 is a lot more money than most of us have sitting around in the bank. But life is priceless, right? (Note that I’m speaking generally, not commenting on this case in particular since I don’t know any specifics – just what was reported in the news.)
Balancing cost with the patient’s health and safety – how to choose the right form of medical transport
At MedFlight911, we work hand-in-hand with the patient’s doctor and case manager to find the right transport for the patient. In some cases, it’s an air ambulance – individual care for a single patient on a dedicated jet or turbo prop aircraft. In other cases, it’s a commercial air medical escort – individual care for a single patient on an international or domestic commercial airline. Sometimes, it’s a ground medical escort – individual care for a single patient on a domestic train or (medical) motor coach.
We also work with the patient’s insurance company to secure coverage for the air medical transport. Many insurance companies will deny coverage out the gate to force the air ambulance company to go through the appeal process. Several air ambulance companies will not expend that effort (the appeals process is a big time investment). At MedFlight911, we will – so the patient can receive (hopefully) the reimbursement they are entitled to.
At MedFlight911 we always put what’s right for the patient first. Air ambulance transport is our main focus, but if commercial medical escort or ground medical escort is in the patient’s best interest then that is what we will do.