PUEBLO, Colo. — Bob Taylor woke up in a panic on July 7, 2022. He was having severe chest pains and worried it was another heart attack.
He and his wife, Marjean, were staying at a friend's cabin about an hour's drive from the nearest hospital in Alamosa.
After Marjean drove him to the San Luis Valley Health Hospital, Bob was told he was having his second heart attack in four months. Doctors said he needed a higher level care than they could provide and that they would transport him by helicopter to the nearest facility.
Bob was loaded onto a Guardian Flight air ambulance and flown about 100 miles to Parkview Medical Center in Pueblo, where his cardiologist was waiting.
"He found a tear underneath one of the stents he put in four months earlier," Bob said, adding that he believes the procedure saved his life.
Bob recovered, and he is now doing well. That's the good news. However, the bad news came in the mail soon after the incident.
Their insurer, Anthem Blue Cross Blue Shield, had denied their claim for the air ambulance ride, stating it was "not medically necessary." The Taylors owed more than $94,000.
"It gave me a heart attack, almost," Marjean said in an interview with Denver7 Investigates.
The Taylors are not alone. Each year, an estimated 550,000 people in the United States are transported by air ambulance, a specially outfitted helicopter or plane that can quickly take critically injured or sick patients to medical facilities. These services often travel to hard-to-reach or rural areas where ground ambulances may be impractical, but can also be used to save time in life-threatening situations.
A Denver7 investigation found that as thesky-high costs for an air ambulance rides are climbing even higher,insurers are often denying claims as "not medically necessary," leaving some customers stuck with astronomical bills.
The Taylors appealed their insurance company's decision twice, both times receiving denials. An independent reviewer upheld the denial decision but noted, “Without medical records from the treating physician, it is impossible to determine the medical necessity.”
"They didn't have enough information"
Adam Fox, deputy director of the Colorado Consumer Health Initiative, said his nonprofit began investigating the case last year.
"We don't know how [Anthem] determined it was not medically necessary," Fox said. "Frankly, based on what we've learned, they didn't have enough information to say it was not medically necessary, and that is a failing on the insurance company.”
Beyond the Taylors' case, Fox said he is seeing a troubling trend.
- Hear more from Adam Fox, whose nonprofit began investigating the Taylors' case, after their insurer denied their claim for the air ambulance ride when Bob Taylor was suffering from a heart attack.
"I think this case potentially demonstrated new behavior that is very concerning by both the air ambulance entity and the insurer," Fox said.
Loren Adler, a fellow and associate director at the Brookings Institution, has been studying this issue for years.
"Inevitably, the insurance company is always trying to save a buck," said Adler, who added that the federal No Surprises Act that went into effect in 2022 was supposed to ban surprise bills for out-of-network costs.
But last year, the National Association of EMS Physicians wrote a letter to policymakers stating that often with air ambulances, they have seen a significant "spike in denials of claims on the basis of 'lack of medical necessity.'"
- You can see that letter in its entirety below.
Under the No Surprises Act, insurers can pass the out-of-network charge to consumers if it is not medically necessary.
"At the end of the day, though, medical necessity is medical necessity," Adler said. "And if the service was medically necessary, the insurance company should be covering it."
However, Adler said insurers have a growing incentive to deny claims. As private equity has moved into the air ambulance industry, his research shows prices have skyrocketed and were roughly 60% higher than providers not backed by private equity.
"Private equity came in and saw this opportunity to be more aggressive, to set very high list prices," Adler said. "So, it is not perfectly clear exactly how things get walked back, short of new legislation."
"Somehow, this case ended up misclassified"
Meanwhile, Technavio, a global market research firm, has reported massive growth in the market, citing the increasing prevalence of medical emergencies, particularly in remote locations.
"The issue with flights is the cost of being ready to go at a moment's notice, 24 hours a day, seven days a week, 365 days a year," said Dr. Melissa Costello, national medical director for patient advocacy at Global Medical Response, which includes Guardian Flight under its umbrella.
Costello said their crews bring ICU-level staff and equipment to places like rural hospitals, where ground ambulances are limited and may not be available for a five-hour round trip, as was the case in Alamosa.
Additionally, as prices for fuel and staff go up, the service has become more expensive to provide.
"There are aviation companies that have been publicly traded, and since COVID, the other two major players in the industry have both become private-equity backed because as a publicly traded company, they struggled and ended up both declaring bankruptcy," she said.
Still, she said Bob Taylor's flight should have been covered by insurance.
"Somehow, this case ended up misclassified, and that's what started this whole thing rolling downhill," Costello said. "The bottom line takeaway from this particular case, and from the work that I do every day, is that if something looks strange, when you get a bill, if you have concerns, anything, you communicate with us."
◼️ WATCH | What are the underlying causes of skyrocketing air ambulance bills?
"I was not going to give up"
While Anthem Blue Cross Blue Shield denied an interview request, a spokeswoman blamed unclear communication in a statement provided to Denver7.
In full, it reads: "Our clinical guidelines are designed to ensure high-quality, consistent patient care through evidence-based recommendations. After reviewing the medical details provided by the air ambulance company, we concluded that air transport was not needed to safely transfer the member to another facility, a decision that was independently confirmed through an external appeals process. However, we later learned that unclear communication from the hospital led to significant confusion and out-of-pocket expenses for the member. In response, we have negotiated with both the hospital and the air ambulance provider to cover these costs and are working together to improve how policies on air ambulance services are communicated in the future."
"I just felt like we were stuck in the middle of all these companies and nobody cared," said Marjean Taylor. "I'm pretty sure — 100% sure actually — that because you contacted Anthem, they reviewed our situation again, and then they called us."
The Taylors said after two-plus years of fighting, the $94,000 air ambulance bill is now taken care of, giving them a sense of relief at last.
"After I got off the phone, I said, 'I cannot believe this is done,' and I started crying," Marjean Taylor said. "But I wasn't giving up. I was not going to give up. I was not paying it."
