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What It Took For This Coronavirus Patient's $80,000 Air Ambulance Charge To Go Away

Celia Llopis-Jepsen
Kansas News Service
Anil Gharmalkar came down with COVID-19 in rural southeast Kansas. When he kept getting worse, his local hospital intubated him and sent him by helicopter to Kansas City in hopes of saving his life.

COVID-19 treatment can cost thousands, even hundreds of thousands of dollars. So it's important to know whether you'll be on the hook for that money.

OSWEGO, Kansas — A vicious bout of coronavirus hospitalized Anil Gharmalkar in April.

The 41-year-old got severely ill, quickly. His besieged lungs fought for enough oxygen to survive. His local hospital in rural southeast Kansas put him on a ventilator and rushed him by helicopter to the University of Kansas Medical Center in Kansas City, where he eventually pulled through. (You can hear him talk about his battle with the illness here.)

The helicopter company charged $80,000, and at first, Gharmalkar’s insurance wouldn’t pay. The difficulties he ran into resolving the matter hold lessons for anyone with COVID-19 medical bills.

A patchwork of laws and company policies mean you may well be shielded from any bills — but you might have to dig to figure out whether that applies to you and then push to assert your rights.

This story is part of our series, Bills of Health. Do you have a medical bill from Kansas that you want to share with a reporter? Email celia@kcur.org.

Gharmalkar and his wife, Jalon Evans-Gharmalkar, fretted for weeks about whether and how much they’d have to pay Air Methods for that chopper flight on their own if Blue Cross Blue Shield of Kansas didn’t pay up. He sought referrals for a lawyer and contacted a reporter.

“We didn't know — for lack of a better term — how ‘generous’ (Air Methods) were going to be if they thought we had assets.”

The family runs a small business with several semi-trucks, like the one that Gharmalkar was driving to deliver refrigerated meat across the Midwest and South when he came down with COVID-19.

The fear that they might need to shell out tens of thousands of dollars came when he was still struggling with after effects of the illness that lingered for months and landed him in the hospital three more times.

But that extra source of stress would have dissolved had either Air Methods or Blue Cross explained that the Gharmalkars couldn’t possibly be on the hook for the money.

That’s not the message they got as they made repeated calls trying to fix the situation. When they asked Air Methods what to expect, they didn’t get a clear answer. When they pleaded with Blue Cross, the insurer rejected their claim a second time.

“No one could say what’s going to happen and what you’re actually going to owe,” he said.

Ultimately, the Gharmalkars did not have to pay a dime toward the $80,000 charge.

A Blue Cross spokeswoman said the insurance company should have picked up the bill from the start.

“Once we looked into it further, did some more investigation, we did determine it was an emergency,” she said. “We also determined that it was COVID related.”

Here is how the Gharmalkar’s claim got resolved — after queries from the Kansas News Service — and some takeaway tips for anyone dealing with COVID-19 bills. And if you don’t find what you need here, also try our Expert Tip Sheet For Pushing Back Against Your Medical Bills.

The Gharmalkar family sit in their Oswego home, three months after Anil's fight with COVID-19.
Celia Llopis-Jepsen
Kansas News Service
The Gharmalkar family sit in their Oswego home, three months after Anil's fight with COVID-19.

A quick refresher on surprise bills

Air Methods is not in the Blue Cross Blue Shield of Kansas network. That’s where things often get tricky for patients — for COVID-19 or anything else.

When you get health care from outside your insurance network, prices can be several times higher than normal. The doctor or hospital or ambulance company bills your insurer. The insurance company may find the price unreasonable and just pay part of it. Then you get billed for the rest.

That is commonly called a “surprise bill,” and it’s separate from any charges for copay, coinsurance or deductibles. It’s usually legal, except in some parts of the country (not Kansas) that have started curbing the practice with state laws.

The Gharmalkars were grateful for the helicopter that whisked Anil to a major hospital in just under an hour. It may have saved his life. And they wanted Air Methods to get paid a fair price. But they also feared they’d soon face a hefty surprise bill if Blue Cross paid little or nothing.

Federal law may protect you against bills for COVID-19 treatment

Because of the pandemic, Congress gave the health care industry emergency relief funds. But it came with strings attached. Companies that took the money — including Air Methods — can’t stick COVID-19 patients with surprise bills.

So ask your biller if they got a slice of the stimulus pie. If so, then you shouldn’t get a surprise bill. If you do, demand that they cancel it.

The federal government also has an online list of the recipients where you can check for specific doctors, hospitals, and more. But the complexity of business ownership and subsidiaries in health care means you might miss what you’re looking for.

Some companies have also made public promises not to bill COVID-19 patients.

Air Methods says it committed not to bill coronavirus patients even before it got federal relief money. Under no circumstances, its executive vice president for reimbursement said in an emailed statement, would Air Methods have billed the Gharmalkars for anything that Blue Cross didn’t pay.

The Gharmalkars would have loved to know that. But say they only got ambiguous assurances that the company hoped to get paid by Blue Cross, and not them.

And it’s hard to tell from the Air Methods website that a hard rule against surprise billing exists. Air Methods pointed the Kansas News Service to a sentence toward the bottom of a blog post that says: “We will work closely with our patients to ensure their emergency air medical service is covered.”

The company’s webpage on COVID-19 billing doesn’t clarify that the company is legally barred from surprise billing patients.

How to tell if your health insurance should cover your COVID-19 treatment.

Likewise, your insurer may also have made commitments that protect you against COVID-19 bills.

Blue Cross announced in early April that it would cover COVID-19 treatment without any cost-sharing for patients with qualifying health plans. That didn’t stop the insurer from twice rejecting Air Method’s claim for transporting Gharmalkar.

Ask your insurer if it has a policy on COVID-19 services, and where you can read it. You may need to read up and then remind them what their own rules say. Pay attention to details including which types of health plans qualify for what, and for how long.

For example, Blue Cross Blue Shield of Kansas plans qualify for full coverage of COVID-19 treatment without cost-sharing if they are what’s called “fully insured.” If you have a “self-funded” plan — often a large employer plan — the terms will vary by employer. Don’t know which category you fall into? Call Blue Cross to check.

The following is covered for fully insured Blue Cross Blue Shield of Kansas plans:

  • COVID-19 treatment until the end of this year, whether at a doctor’s office, urgent care facility, emergency room or as a telehealth patient or hospital inpatient.
  • Also until the end of this year: Medically necessary diagnostic tests related to COVID-19 and the related telehealth or physical visit to the doctor's office, urgent care or emergency room. If you got, say, a flu test, and it led to the doctor ordering a COVID-19 test, too, then the flu test would also be covered.
  • COVID-19 antibody testing “for the duration of the declared public health pandemic.”

You should also ask your insurer what “no cost-sharing” means in this context. A spokeswoman for Blue Cross Blue Shield of Kansas said it means no copays, deductibles or surprise bills.

So how did Gharmalkar’s $80k charge get resolved?

Insurance statements started piling up soon after Gharmalkar’s hospitalization, alerting him to hundreds of thousands of dollars in charges for the life-saving care that got him through COVID-19.

To his relief, Blue Cross swiftly approved most of the claims. A few, he says, took a bit of work to clear up coding errors. The situation over his helicopter ride was the most difficult.

After Blue Cross rejected the bill the first time, Air Methods tried contacting the insurer on his behalf again to show the helicopter ride had been a medical emergency. But Blue Cross sent him another statement showing it wouldn’t pay anything toward the $80,000 bill.

Gharmalkar signed a federal medical privacy, or HIPAA, release form allowing the Kansas News Service to make inquiries on his behalf. He says his insurer swiftly circled back to him and said it was working on the claim.

Air Methods says it kept pushing, too, seeking to negotiate directly with Blue Cross. Ultimately the two parties agreed on a price: $23,339.

His win might help other people in Kansas. Air Methods says it approached Blue Cross Blue Shield of Kansas repeatedly in recent years to no avail, trying to strike a broader deal that would bring the helicopter company into the insurer’s network.

Blue Cross disputes that characterization. Regardless, both sides — one of the nation’s biggest medical helicopter providers and Kansas’ largest commercial health insurer — now say negotiations on a network deal are in the works.

Air Methods, which flew around 350 medical flights in Kansas last year, says talks only began in earnest in the middle of Gharmalkar’s case.

Bonus tip: There’s a state insurance department. And it can help you.

If you think you’re being asked to pay for coronavirus-related treatment in error, and you’ve tried to resolve the matter with your insurer, call your state insurance department.

“This is exactly the type of thing that they’re there for,” said Maanasa Kona, a professor at the Center on Health Insurance Reforms at Georgetown University. “If an insurance company is giving you the runaround, you should be able to reach out to the department of insurance and ask them to step in to see what’s going on.”

In Kansas, you can call the department’s consumer hotline (800-432-2484), send an email or fill out this online complaint form.

Last week, the department issued a consumer alert reminding people that insurers must cover COVID-19 testing without patient cost-sharing if the test was for diagnostic purposes. That’s related to another recent federal law.

But understanding the wrinkles of that law can be tricky, so Kansas Insurance Commissioner Vicki Schmidt suggests calling her agency if you’re worried you were wrongly charged, and haven’t had luck asking your insurer about it.

“We really want people to give us a call and let us help them weed through this,” she said. “It’s more complicated than what meets the eye.”

Celia Llopis-Jepsen reports on consumer health and education for the Kansas News Service. You can follow her on Twitter @celia_LJ or email her at celia (at) kcur (dot) org.

The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio focused on health, the social determinants of health and their connection to public policy. Kansas News Service stories and photos may be republished by news media at no cost with proper attribution and a link to ksnewsservice.org.

I'm the creator of the environmental podcast Up From Dust. I write about how the world is transforming around us, from topsoil loss and invasive species to climate change. My goal is to explain why these stories matter to Kansas, and to report on the farmers, ranchers, scientists and other engaged people working to make Kansas more resilient. Email me at celia@kcur.org.
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