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Air medevac: expensive – but lifesaving

A HealthNet Aeromedical crewman loads a gurney onto a medevac helicopter. Each medevac chopper is manned by a pilot, flight nurse and paramedic.
A HealthNet Aeromedical crewman loads a gurney onto a helicopter. Each medevac chopper is manned by a pilot, flight nurse and paramedic.

The mountains of West Virginia are beautiful but present problems for ground transportation. Rapid travel over highways is impossible in most areas of the state. When an injured or ill person must be transported to a hospital quickly, the state’s slow-go terrain becomes a danger to life and limb.

Fortunately, medical evacuation (medevac) by helicopter has become available in West Virginia. But it is expensive, especially for patients transported from remote Pocahontas County. Local patients pay more than $25,000 for a medevac flight to Charleston, and the cost for a flight to Morgantown exceeds $30,000.

During the Vietnam War, the UH-1 “Huey” helicopter became a familiar sight in TV news reports, as it landed and evacuated troops from combat zones. For the first time in history, helicopters played a major role in combat, and the value of using helicopters in a medevac role became apparent. Medevac choppers, known as “dustoffs,” helped to greatly reduce the mortality rate for wounded soldiers, compared to WWII.

The first hospital-based air medevac service in the U.S. started in 1972 in Colorado – another state with difficult terrain. It would take another 14 years before West Virginia would have a private air medevac service.

In 1986, West Virginia University Hospitals and Charleston Area Medical Center worked together to create HealthNet Aeromedical (HNA), the state’s first private air medevac company. Cabell-Huntington Hospital joined the partnership in 1987. HNA is a non-profit company, wholly-owned by the three hospitals.

Today, HNA and two for-profit air medevac companies provide service in Pocahontas County. Air Evac Lifeteam operates from a base in Summersville. Carilion Clinic Life-Guard picks up patients to be treated at Carilion Roanoke Memorial Hospital. HNA serves the county from a base in Buckhannon.

Patients have no choice which company provides the flight. State EMS procedures mandate that the closest available aircraft will be dispatched for a needed flight.

HNA operates six bases in West Virginia and one base each in Ohio and Kentucky. HNA Base 6, in Buckhannon, supports Pocahontas County. The company’s headquarters and training center is located in Charleston.

For a recent HNA air medevac flight from Pocahontas Memorial Hospital (PMH) to Ruby Memorial Hospital in Morgantown, the patient received a total bill of $31,163. The bill included a “liftoff fee” of $12,478 and a mileage fee of $18,685 (101 miles at $185 per mile). All HNA invoices for air medevac include the standard liftoff fee and a mileage fee based on distance transported.

HNA Director of Business Development Jason Spears expressed confidence that the two for-profit companies charge even more.

“I would bet you that they are a lot more than what you see right here,” he said.

In an email, HNA President Clinton Hurley wrote that insurance often covers the full cost for an air medevac flight.

“The structure of each health insurance policy is different,” Hurley wrote. “While most carriers will cover air transportation, we urge policy holders to inquire with their agent regarding coverage limitations before the need arises.”

HNA Director of Accounting Brian Doughty said insurance companies generally cover the full amount.

“It’s not like getting a colonoscopy, where you decide to go to your in-network guy or your out-of-network guy,” he said. “Insurance companies have realized what kind of a need this is, especially in the rural areas, and have just pretty much paid.”

Medicare and Medicaid pay a portion of the cost.

“Both Medicare and Medicaid pay pre-determined amounts toward the cost of air ambulance services,” Hurley wrote. “While the payment may not cover the full amount, HealthNet Aeromedical Services is somewhat limited in its ability to recoup additional dollars from patients covered under these plans.”

VA-eligible veterans are covered.

“The VA does cover the cost for medically appropriate air transport,” wrote Hurley. “When a transport is considered to be non-life or limb threatening, the VA prefers to give prior authorization.”

Spears said HNA’s non-profit status restrains the company’s collection efforts.

“Our collection agency does not call and harass people,” he said. “We would never jeopardize our not-for-profit status over that. That is not our mission. We feel that we are here to provide a service for the community, whether they can afford it or not.”

Both PMH and HNA officials stressed that patients are transported without regard to their ability to pay. In a system in which saving lives takes precedence over making money, more than half of HNA invoices never get paid.

“Of our total collections, system wide, we probably write off in the neighborhood of 50-55 percent,” said Spears.

Liftoff and mileage fees are adjusted to offset unpaid bills. In effect, paying customers pay more to cover the costs for non-paying customers.

“It has been said that in health care reimbursement, the few pay for the many,” wrote Hurley. “That can also apply to air medical transport. While our fixed costs for aircraft, staff and medical equipment are high, we must also budget for non-collectible accounts and shift those costs to others.”

Contributions from HNA’s three owning hospitals help defray costs.

“HealthNet Aeromedical is fortunate to be wholly owned by the state’s leading academic medical centers,” wrote Hurley. “They recognize the value in the delivery of safe, high quality critical care transport services. As such, our owner hospitals make annual contributions to the organization, effectively subsidizing these critical services.”

Hurley said special insurance is available that covers the full cost of an air medevac flight, no matter which company provides the service.

“The Life Shield Alliance provides insurance that covers patients transported by all air medical transport organizations,” wrote Hurley. “Those holding insurance are not limited by the specifics of a membership model plan. The Alliance can be reached at 855-896-9064 or at”

On its website, Life Shield Alliance advertises an individual rate of $49.95 per year and a family rate of $59.95 per year.

See next week’s edition of The Pocahontas Times for a follow-up article, including a look inside HNA’s training academy and a visit with a medevac air crew.

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