posted May 18, 2018

When Karen Espinosa suffered a stroke last year at her home in Lake City, Florida, she met the Florida criteria for a Stroke Alert. Thanks to the Florida Standard of Care, this meant she had to be transported by the fastest means available to a stroke center.

In her case, helicopter transport from Lake City was the quickest way to get her to treatment at North Florida Regional Medical Center in Gainesville. Upon her arrival, the medical team found a clot that stopped the blood flow to a large portion of her brain. Threading a hair-thin catheter through a vein, they suctioned out the clot and Karen began to improve immediately.

There are very few conditions that are as time-sensitive as a stroke.

Getting a patient to a stroke center where they can receive definitive care very rapidly plays a huge role in the outcome. Thanks to the quick treatment Karen received, she was able to make a full recovery and return to her job at the Veterans’ Administration (VA) just ten days later.

Karen and her husband, Alan, were grateful for the air ambulance service that helped make her recovery possible, but they were shocked when they found out their insurance company covered the entire $187,000 hospital bill, but would only cover a quarter of their air medical bill.

Unfortunately, this is a common occurrence for patients who rely on air medical for lifesaving treatment. Although the government reimburses hospitals for 94 percent of the cost of providing emergency care to the indigent, companies that fly the injured to those hospitals get less than 40 percent, on average, for these calls. That shifts the burden onto insurers, who often reimburse at a fraction of the cost, leaving patients facing financial peril when they are their lowest point physically.

Luckily, Alan Espinosa had two important things on his side. First, he is a veteran paramedic who knew that Florida law protects patients who meet a Stroke Alert from air ambulance bills.

Second, he was working with Air Methods Patient Advocate, John Laudadio. John helped the Espinosas strategize, told them how to write a written appeal, and joined Alan and the insurer on the line for conference calls. He explained procedures and helped nudge the case along when it seemed to have fallen between the cracks.

“It was a six-month long process,” Espinosa said. “We finally got the insurance company to pay the entire bill.”

It turns out that not even his insurance company knew about the Florida law that not only protects stroke victims, but other types of traumatic injuries and illnesses as well.

“Florida has a trauma alert system which applies to trauma. We also have a STEMI Alert system, which applies to victims of heart attack, which says the same thing: transport by the fastest available means,” he said.

Alan believes that, like his insurance company, very few consumers know the protection is there; albeit limited. So he is working to get the word out to other patients who meet one of the mentioned health alert conditions.

“I would encourage everybody to look into that small part of their insurance policy to see what the insurer’s responsibility and what the insured responsibility is, in the event that they need air medical transport,” he said.