LOVELAND, Colo. (KDVR) — Matthias Spiegel is a healthy 18-month-old toddler. But on the day he was born, Sept. 17, 2021, breathing issues convinced hospital staff at the Medical Center of the Rockies that he needed to be airlifted by helicopter to Children’s Hospital Colorado in Aurora.
“So they just hand a tablet and say, ‘Will you sign this?’ You know, for Children’s (Hospital) to take care of him, and they’re like, ‘The helicopter’s already in the air,'” Matthew Spiegel, Matthias’ father, said.
Spiegel told FOX31 he felt like he didn’t have much choice in the matter, but he never guessed the bill for the 49-mile air ambulance trip from Loveland to Aurora would be $61,557.
His health insurance provider, Anthem, paid Global Medical Response the in-network rate of $8,186 toward the bill. But because the air ambulance company is out-of-network, Spiegel was told he was on the hook for the remaining $53,370.
“Pretty much the only thing I could rely on was that my son was still here, so that sort of calmed me down. I couldn’t exactly lose it. But yes, it was a major league shocker,” Spiegel said. “They gave us the option of paying $200 a month over 21 years.”
No Surprises Act prohibits ‘predatory’ medical bills
If Matthias had been born four months later in January 2022, when the No Surprises Act became law, his parents wouldn’t owe any money beyond what their insurance provider paid. The new federal law passed by Congress prohibits air ambulance companies from collecting more than the in-network rate insurance companies have agreed to pay.
“I think these sort of bills, $60,000, are predatory,” Loren Adler, associate director for the USC-Brookings Schaeffer Initiative for Health Policy, said.
“Over the last 15-20 years, we’ve seen a pretty rapid growth in how much air ambulance companies are charging,” Adler said.
Adler, who has studied the issue of air ambulance bills nationwide, said the meteoric rise in air ambulance bills can be traced to private equity firms like Global Medical Response, which bought air ambulance companies knowing they could jack up rates by refusing to contract with insurance companies and generally charge whatever they wanted without government oversight.
“To the patients themselves, the No Surprises Act should be a complete game changer,” Adler said. “The law provides a very important protection that I think, honestly, most people thought already existed. You know, most people think it just sounds absurd that this could even happen. But now that protection does exist.”
Under the No Surprises Act, air ambulance companies can’t collect more than the in-network rate a health insurance provider negotiates, which is usually more than Medicaid pays.
Under the Medicaid formula, the Problem Solvers estimate the air ambulance company would’ve been paid $4,923.
Spiegel’s plan, under Anthem insurance, paid $8,186, a fraction of the $61,557 that was billed for the 49-mile trip. The total bill works out to $1,256 per mile.
“Hard to really figure out whether, you know, $8,000 is the precisely correct number. I do think, however, that it’s very hard to argue that $60,000 is the correct number,” Adler said.
Spiegel agreed: “It’s entirely way too much for that service.”
Air ambulance company declines to comment
Global Medical Response declined to answer any questions from the Problem Solvers and would only say in an email, “Due to patient privacy laws, we cannot discuss any details surrounding a specific transport. Our patient advocates have been in contact with the family to resolve the reimbursement issue.”
The response from Global Medical Response was disingenuous because the Problem Solvers mentioned from the beginning that the Spiegels would sign a privacy release form and did so for Anthem insurance.
Anthem contacted Matthew Spiegel’s employer (who FOX31 has agreed not to name), and the employer eventually agreed to pay off the entire amount on the Spiegels’ behalf, except for the $44 the couple still had to meet to reach their out-of-pocket cap in 2021.
In a statement, Anthem told FOX31:
“Anthem Blue Cross and Blue Shield has an extensive network of care providers it contracts with to help ensure access to affordable and high-quality care. Prior to the passage of the No Surprises Act many air ambulance providers chose not to contract with insurers because it allowed them to charge any fee for services as they were not bound by contracted rates. Anthem was a strong advocate for the federal No Surprises Act, which now keeps our members out of the middle of fee negotiations with providers who refuse to contract with insurers.”
The No Surprises Act might not have helped the Spiegel family, but Matthew Spiegel said now that it’s the law it should “very much help a lot of people.”