ELLSWORTH — On Jess Jordan’s first day of orientation at Kmart in Bangor three years ago, her cell phone wasn’t working. So when the call came in — her 2-month-old son, Landon, had been found unresponsive and not breathing in his crib — a staff member pulled her aside to hand her a store phone.
“I beat LifeFlight [to Northern Light Eastern Maine Medical Center],” said Jordan.
Landon had first been brought by ambulance to what is now Northern Light Maine Coast Hospital in Ellsworth, but providers quickly determined they didn’t have the resources to care for him, and made the recommendation to airlift him to the hospital in Bangor.
“LifeFlight was the quickest way to get him where he needed to be,” Jordan said.
It’s a common story in rural communities across the country, where complex medical care may be hours away. And for patients and their families, an air ambulance is often the only choice, and possibly the difference between life and death.
But in some places, that choice has proven to be an expensive one, with families later facing bills of tens of thousands of dollars, charges commercial insurance may not cover.
And because of the way the rules are currently written, there’s not much states can do about it.
“A state can regulate ground ambulances and hospitals and doctors and everybody else in ways that they cannot regulate an air ambulance,” said Tom Judge, executive director of LifeFlight of Maine, the nonprofit transport company whose helicopters and airplanes are regularly seen cutting through the Maine skies.
“Now you have private equity as the biggest companies in the air ambulance space. They’re venture capitalists,” Judge continued. “They’re trying to make money and they can — but that’s when you see rapidly increasing charges.”
The median cost for an air ambulance roughly doubled between 2010 and 2014, according to a report by the Government Accountability Office, from $15,000 to $30,000 — despite the fact that there are roughly 10 times the number of helicopter ambulances flying now compared to the mid-1980s.
“There were two things that happened,” said Judge. The first, the Airline Deregulation Act of 1978, prohibited the government from controlling fares, meaning unless the ambulance company has a contract with an insurance company or the government, it can basically charge whatever it wants.
The second piece of legislation that tipped the scales toward air ambulances, said Judge, was The Balanced Budget Act of 1997.
“The biggest winner was helicopters, the biggest loser was ground critical care,” said Judge. “There was suddenly a lot of money flowing into the system.”
“In 2009, the for-profit companies started rapidly increasing charges,” said Judge. “Twenty, forty percent per year. And they refused to contract with insurance companies,” which meant even patients with insurance are often left with huge bills.
Except, said Judge, in Maine.
“People read the national news and they see things on the television. They’re like ‘Oh my God, if I get put in a helicopter I’ll get a $50,000 bill,’ but you won’t get that in Maine.”
The average charge for a LifeFlight ride in Maine is $15,000, said Judge, and the organization, which transported 2,237 patients last year, has contracts with every major insurance carrier in the state.
That figure is in line with LifeFlight patients The Ellsworth American spoke to.
Gary Grovogel, who was airlifted to Bangor from Ellsworth after being hit in the eye with a piece of wood, remembers the helicopter ride costing around $8,300.
“Everybody complains about Obamacare,” said Grovogel, “but if I hadn’t had it I probably would still be paying for it.”
He was in intensive care for five days.
“My insurance covered the full amount.”
Liam Somers, who was biking in Acadia when he hit a car parked on the side of the road and severed several arteries in his neck, credits LifeFlight (and several quick-acting passers-by) with saving his life.
“If I hadn’t gotten to the hospital when I did — even two minutes later,” said Somers, who was airlifted from Bar Harbor to Bangor, “my airway would’ve closed. I would’ve either died or suffered irreparable brain damage.”
LifeFlight billed his insurance company, Aetna, for the ride, which Somers remembers lasting “between 15 and 18 minutes — really quick.”
“The helicopter ride itself was in the neighborhood of $12,000,” said Somers. His total bills — he was in a medically-induced coma for two days and in the hospital for three or four — were around $50,000.
“It’s a shock to the system,” said Somers. His insurance covered most of it, although he had to pay what he remembers being “a few thousand dollars out of pocket.”
He knows that that’s no small amount.
“If you don’t have insurance that’s catastrophic and I get that,” he said. “But I would be dead today, if not for LifeFlight. These people cared for me in the way that you would care for your mother. They checked up on me, they contacted me afterwards.”
In the case of little Landon, Jess Jordan’s son, the family was covered under MaineCare.
“I never saw a bill,” said Jordan. “I couldn’t imagine how much that would’ve cost us. I’d probably still be paying for it now.”
I was in contact with LifeFlight for awhile,” Jordan continued. “I wanted to say thank you. I got the names of everyone that was on the crew.”
Judge said LifeFlight keeps costs down by running as lean as possible.
“We try to do everything we can to align as closely as we can costs and charges,” he said.
In 2015, according to industry publication The Association of Air Medical Services, the median cost to run an air ambulance transport in 2015 was $10,199.
But as is a common complaint among health care providers, both government programs paid a fraction of what the Association says it costs to provide care: Medicare reportedly reimbursed companies at a median rate of $5,998 per ride, while Medicaid paid $3,463. Uninsured patients paid around $354.
In some cases, that has meant that patients with commercial insurance have shouldered the rest of the burden. And because an insurance company may not cover the entire charge, patients are left to pick up the tab, a practice known as balance billing.
LifeFlight had around $2.3 million in bad debt last year, said Judge, money it will likely never collect. The organization tries to make up the difference via grants and donations. Check your town’s budget — it’s likely it donated to LifeFlight last year.
Amounts run the gamut and vary by year, from $513 in smaller towns such as Mariaville to the recent efforts of residents in Port Clyde and Tenants Harbor, who raised $6.5 million for a new LifeFlight helicopter after a horrific crash on the Monhegan boat dock claimed the life of a 9-year-old boy in 2014.
“LifeFlight became integral to saving people’s lives,” said Judge. “That was our mandate. They gave us a sheet of white paper and said ‘Don’t compromise safety, make this world class and there’s not very much money, so you’re going to have to run this as lean as you can’.”
Since 2011, LifeFlight of Maine LLC has brought in between $7.9 million and $10.4 million in revenue from its program services each year, while expenses hover in the $8 million to $9 million range. There is also a separate but affiliated entity, the LifeFlight Foundation, which brought in roughly $2 million in fiscal year 2018. It recorded a loss of $767,094 after expenses, although that “reflects the funds that came into the Foundation and were then transferred over to LifeFlight of Maine to support programs, aircraft and medical equipment,” said Melissa Arndt, the organization’s director of communications, in an email.
For patients in areas of the country where costs have continued to rise, regulators in Washington are attempting to address the issue. The Air Ambulance and Patient Billing Advisory Committee (of which Judge is a part) is studying how to bring costs down (he is on the committee).
“The people on the ground are trying to do the right thing,” said Judge. “In the background the finance company is doing something different. It’s heartbreaking.”
He continued. “We’re trying to sort this out.”