I hear a lot of medical billing horror stories. The latest involves Paul Witkowsky, an English professor at Radford University, who is fighting a bill for $18,590.99. He's 64 and until February was in great health. Then he suffered a stroke early in the morning at his house.
His wife, Maria, dialed 9-1-1 and paramedics arrived shortly at his Radford home. Witkowsky was mumbling and couldn't move the left side of his body.
The idea in such cases is to get the patient to a hospital as quickly as possible, especially to a place with a specialized stroke unit. Carilion Roanoke Memorial Hospital has one.
An ambulance took Witkowsky to the helipad at Carilion New River Valley Medical Center, where he was put on a copter and flown to Roanoke Memorial.
"I spent five days in the hospital, where I was given state-of-the-art treatment," Witkowsky told me. The great news is, he fully recovered from the stroke.
Here's the bad news: Med-Trans Air Medical Transport is now dunning Witkowsky for the unpaid balance of his helicopter flight to Roanoke. The Texas-based contractor provides medevac services for Carilion.
Witkowsky's problem is that his insurer - Anthem, the dominant health insurance company in Western Virginia - has no provider agreement with Med-Trans.
Until February 2012, Carilion operated two Life-Guard helicopters through another contractor. But Carilion did the billing and transports were covered under provider agreements the hospital corporation had with private insurers.
Then Carilion changed contractors for its medevac helicopter operation to Texas-based Med-Trans, which operates in 18 states.
Out of that deal, Carilion got a third helicopter, and better medical equipment aboard all three. One is based in Lexington, a second is based in the New River Valley and a third is hangared at Smith Mountain Lake. Part of the deal was that Med-Trans would do its own billing.
At the time Carilion and Med-Trans entered into their agreement, it was Carilion's "understanding and expectation that Med-Trans would work out a provider agreement with Anthem as soon as possible," said Eric Earnhart, a Carilion spokesman. He declined to say if that was explicitly part of the contract.
Seventeen months later, no agreement has materialized. And Med-Trans has no provider agreements with any other health insurers in Virginia either, said Reid Vogel, a Med-Trans spokesman.
"We respond when called, regardless of the patient's ability to pay, Vogel said. "Often we transport patients without insurance or the ability to pay. Similar to other health care organizations and services provided, this shifts a greater burden on viable payers."
That suggests anyone transported by a Carilion Life-Guard helicopter could wind up in the same boat as Witkowsky.
His initial bill from Med-Trans for the airlift was $23,975. That included $17,500 just to get the copter off the ground, plus a fee of $185 per mile for 35 flight miles.
When he got an explanation of benefits from Anthem, it listed the "allowable charge" as $6,031.79, of which Witkowsky was responsible for $647.78 in co-insurance. Anthem paid $5,304.01.
At first, Med-Trans helped Witkowsky appeal to Anthem. Those appeals were denied. In Anthem's last letter to Witkowsky, it informed him his appeals were exhausted.
Then Med-Trans sent Witkowsky a bill for the unpaid balance, $18,590.99.
Med-Trans' Vogel said: "We believe the insurance provider should be paying the entire amount minus normal patient deductible/out of pocket, just like the majority of the other providers across the country do.
"In this particular case, insurance reimbursement was substantially lower than the standards in place across the country. Our hope is that there is a resolution with the insurer soon, ultimately benefiting the patients."
Scott Golden, a Virginia spokesman for Anthem, said the insurer has contracts with five other air ambulance companies.
"We have had a continuing dialogue with Med-Trans since Carilion contracted with them. We have offered them fair and equitable rates. ? We have offers on the table and if they would like to accept them, we would love to have them be a part of the network."
Witkowsky said he holds Carilion partly responsible.
If [Carilion] signed with Med-Trans with the understanding and expectation that Med-Trans would sign a contract with Anthem, and it's been 17 months, then I'd say Carilion has dropped the ball," Witkowsky said.
Earnhart said: "We are disappointed that it has taken longer than anticipated, but it is still our expectation that an agreement will be reached."
Monday, Witkowsky called Med-Trans' "self-pay advocate" and objected to the $18,590 bill. He said the woman he spoke to offered to discount it by 10 percent.
"I said, 'I'm not paying that,'" Witkowsky told me. "And she said, 'What will you offer?' "
He told her he'd pay the $674 that Anthem had designated as his co-insurance.
She said she would run that by her supervisor and get back to him. But she hadn't by Monday evening.
So for now Witkowsky is stuck in the middle, for lack of that agreement between Med-Trans and Anthem.
What I want to know is, how many others are, too?