Sep 1 2009
Last year, Sally (a patient suffering from end stage liver failure) was in need of life flight transportation to be evaluated for a liver transplant. Her doctors told her she needed to receive the evaluation in order to get on the transplant list. Travel by ground ambulance or commercial flight were not an option due to her condition. Her health insurance company told her they would not cover the air ambulance medical transport. But last week, after four appeals and countless hours of work by Angel MedFlight's patient advocates, that decision was reversed. The insurance company will now pay the full amount of the air ambulance service provided by Angel MedFlight.
"When health insurance companies deny authorization every air ambulance company runs for the hills," said Jeremy Freer, Angel MedFlight CEO. "If they cannot get paid in advance, either from insurance or from the patient's family, they will not conduct the life flight. That's one of the big differences that sets Angel MedFlight apart from other air ambulance services. We will provide the care needed by the patient when no one else will."
Like many health insurance companies, Sally's insurer initially refused to approve the air ambulance service on the grounds that it was "not medically necessary." At that point, she was faced with two options: (1) giving up the chance of a transplant, or (2) taking the time to try and raise thousands of dollars for the life flight. "Sally may have had options but, sadly, she did not have extra time," Freer said. "That is when Angel MedFlight stepped in, reviewed her insurance policy and conducted the flight."
After conducting the life flight, Angel MedFlight's legal team, led by attorney Kelly LoCascio, Esq., went to bat for Sally. The claim was governed by the Employee Retirement Income Security Act of 1974 (ERISA), a federal law governing most health insurance policies that LoCascio says most patients and even many lawyers do not understand.
"Unfortunately, some health insurance companies frequently deny coverage for health benefits when they should be paid," LoCascio said. "They deny claims knowing patients will not understand the intricacies of ERISA law and often do not have the resources to hire a lawyer. Sometimes the patient is too involved with their health or just tired of the fight, and subsequently will miss crucial appeal deadlines. We take on the battle so our patients don't have to. In Sally's case, the system worked; Angel MedFlight performed the service, the insurer denied benefits, and after much exhaustive effort Angel MedFlight ensured that the insurance company carried out their obligations."
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