FLAGLER COUNTY, Fla. – On April 15, in the middle of the night, a police officer came to Stacie Jackson’s door.
“He just said that, ‘Your son’s been shot in the abdomen, and he’s on his way to Halifax hospital right now via medevac,’” Jackson told the News4JAX I-TEAM. “So immediately when I hear that he went via medevac, my head’s just running wild with you know, ‘Is my son going to be OK?’”
Fortunately, he was. Jackson’s 17-year-old son was flown 26 miles from Flagler County to a hospital in Daytona Beach. He had a fractured rib and a contusion on his lung, but he was released in less than a day.
“After I got over that, the initial shock, and I realized he was going to be OK, I did start to think about the medical bills,” Jackson said.
But she wasn’t too worried. She has health insurance and figured she wouldn’t owe more than her deductible of a few thousand dollars.
She thought wrong.
While her insurance agreed to pay roughly $16,000, Jackson said, she got a bill for about $26,000. Jackson said the first thought that went through her head when she saw that was: “How am I going to pay this?”
“How can this happen when you always have insurance and, you know, you take care of things like this and you make sure that I contribute every month to a health savings account, enough in there to pay my deductible?” Jackson said. “I never expected to have an expense like this. I never expected this to happen.”
It was a surprise bill. Instead of hashing out the cost with the insurance company, the provider sent a bill to Jackson demanding payment. It’s a practice Florida restricted in 2020 when Gov. Ron DeSantis signed into law House Bill 747 banning these types of bills. But the law only applies to health plans governed by Florida law, so Floridians like Jackson who have a health plan through a national company that does business beyond Florida are not protected by the law.
“I feel let down,” Jackson said. “I feel, you know, disappointed.”
The I-TEAM learned that the air ambulance from provider Med-Trans was out of Jackson’s insurance network, but because her son’s flight was an emergency, there was never a choice.
According to Audrey Brown, president of the insurance trade association Florida Association of Health Plans, there’s no incentive for air ambulances to go in-network.
“They remain out-of-network and that, therefore, they can charge whatever they see fit,” Brown said.
According to the medical journal Milbank Quarterly, research found more than 75% of helicopter air ambulance trips were out-of-network from 2014 to 2017.
And while it is expensive to run an air ambulance service, there is no cap on what they can charge because of the Airline Deregulation Act of 1978, which bans the government from regulating airlines’ fares and routes — including air ambulances.
The company that picked up Jackson’s son, Med-Trans, says on its website its part of a company that transports more than 100,000 patients each year and is a subsidiary of the global investment firm KKR, which describes itself as managing $429 billion worth of assets as of June 2021.
“How can you expect someone, you know, no matter how hard you work, to just all of the sudden receive a $27,000 bill in the mail and you just be able to pay that with just with no consequence to them?” Jackson said.
So how much does it actually cost to run an air ambulance?
“I showed you the bill,” Jackson said. “There’s not really an explanation of what exactly that they’re charging for.”
Consumer advocate Mary Daniel, president and founder of ClaimMedic, says there doesn’t seem to be a formula for air ambulance billing.
“We see $50,000, $60,000, $70,000 all the time…they bill, and I think they just see what happens, ‘Let’s send this bill, let’s see how much we get paid, and then we’ll go from there,’” Daniel said.
According to the nonpartisan Brookings Institution, the cost of running an air ambulance service varies, but the price has gone up in recent years. Its analysis of charges from 2017 found companies held by private equity, including KKR, charged the most — an average of about $48,000 per transport.
“To me, it just seems, like, if they billed fair prices, this wouldn’t even be an option,” Jackson said.
By 2017, KKR and one other private equity firm controlled nearly two-thirds of ambulances available in the Medicare market, according to the Brookings Institution. The Brookings Institution reports the higher costs for air ambulances are passed along to consumers through higher insurance premiums, higher costs to cover underpaying public providers, and surprise bills.
“I’ve thought about refinancing my house,” Jackson said.
Jackson said that after her son was shot, the family felt chased by an air ambulance company that was trying to collect.
“This is his senior year, and he’s already told me he doesn’t want his senior pictures because, ‘Mom, my friends told me they’re, like, they can be like thousands of dollars.’ He said, ‘I don’t want you to pay that. We need to pay, you know, these bills, and we need to focus on you know things like that,’” Jackson said. “So that was, like, heartbreaking to me.”
Monroe County in the Florida Keys has found a cheaper way by using a program run out of the fire department called TraumaStar. It charges a flat fee of $12,000 per liftoff, plus $100 per mile — as long as you’re a resident. But visitors to the area can still get a surprise bill.
Former state Rep. Holly Raschein said it worked well for her constituents in the Keys for years.
“If we can do it in the Keys, they can certainly do it in other communities,” said Holly Raschein, who’s now on the Monroe County Board of County Commissioners.
If Jackson had had such an option, the cost would have been just shy of $16,000 — a little less than what her insurance initially paid.
Jackson fought the $26,000 bill for months. Finally, after filing complaints and going through arbitration, the air ambulance company dropped her charge to $0 pending additional payment from Jackson’s insurance.
“If anyone finds themselves in a similar situation, you know, fight back. Work with your insurance company, you know, because this really is a very unfair practice…and the law has recognized that and is taking steps to change it,” Jackson said. “So I’m happy about that.”
Med-Trans and KKR have not responded to our questions other than to say Med-Trans had come to an agreement with Jackson’s insurance company.
The federal government is also stepping in to protect policyholders from getting similar surprise bills. Congress passed the No Surprises Act. Basically, it requires out-of-network providers and the insurance companies to hash out disagreements about payment among themselves without involving the patient by sending surprise bills. It’s scheduled to go into effect Jan. 1; however, doctors and hospitals are fighting to delay the new law, concerned it unfairly favors insurers, which they say would result in providers being paid too little.