Terry Law, a carpenter from Rocky Mount, was working on a metal roof in Callaway on July 8 when he fell about 8 feet and cut his pinky finger and two others. The ambulance crew that responded called in a helicopter to take him to Carilion Roanoke Memorial Hospital.
"They had him on a gurney and they were putting him in an ambulance," recalled his boss, Darrell Mullins. "One [of the paramedics] said, 'Terry, are you ready to go for a helicopter ride?'
"I said, 'Are you serious? You're going to airlift him to Roanoke for a cut finger?' He said, 'It's too risky not to.' "
The hospital discharged Terry a few hours later, with 18 or so stitches for three cuts on his hand. About a week and half ago, Law got the bill for the flight from Med Trans, Carilion Clinic's air ambulance contractor. It was for just under $22,000. Law, 32, has no insurance and no way of paying it.
Law still doesn't understand why he was flown to Roanoke. He said he could have gotten to a hospital in Rocky Mount by ambulance faster.
"It was stitches, you know what I'm saying?" Law said.
Glenna Kern, 60, had a stroke in her home near Roaring Run in Alleghany County one Saturday in April 2012. She was taken by ambulance to LewisGale Hospital Alleghany in Low Moor and spent the weekend there, mostly unconscious. The following Monday the hospital had her flown via Med Trans to the University of Virginia Medical Center in Charlottesville. The bill was $27,686.
Anthem, which covers her through her husband Edwin's job, paid $7,785 for the flight, Kern said. Med Trans billed Kern and her husband Edwin for the nearly $20,000 balance.
Kern says she haggled on the phone with Med Trans for a long time. Finally, "I threatened to take them to court," she told me. "I told them the hospital called them, not me." Med Trans cut the bill by $10,000 and agreed to accept $25 per month from Kern to pay off the $9,900 balance. At that rate, she'll be paying for 33 years.
In August 2012, Carol Sue Slusser's husband, Michael, was admitted to Carilion New River Valley Medical Center for acute pancreatitis. He spent a week in intensive care there, but his health was declining. So he was flown via Med Trans to Charlottesville where he spent two weeks in intensive care.
In an email last week, Slusser told me she believes that without that flight to UVa Medical Center, "I may have lost him." Still, she was shocked when she got the helicopter bill: $32,625.33. Anthem paid $9,129 of that. The Slussers were billed for the balance, $23,495.
Med Trans offered to cut it to $10,500 if the Slussers paid the balance immediately in 30 days. They also offered two alternative payment plans: one over six months and another over 60 months, Slusser said.
"My husband is on full disability, due to a non-related medical condition," she said. "We are not in a financial situation to make any of these payments."
"Before the transport, I was asked if he had health insurance and I said yes, with Anthem. Never was I informed that the company that would be transporting him from an in-network facility to another in-network facility, was an out-of-network provider.
Those stories are merely three of more than a dozen people who have called or written me since Tuesday's column about Radford professor Paul Witkowski and the $23,975 bill he got for a helicopter flight to Roanoke after he suffered a stroke. Anthem, his insurer, paid $5,304 for that.
Roughly 80 to 90 patients a month are flown via Med Trans to Roanoke Memorial in summer months and fewer in the winter, said Eric Earnhart, a Carilion spokesman.
Witkowski, 64, has fully recovered, but he's balking at paying the balance. Recently, he got an offer of some help from Pat Palmer, owner of Medical Recovery Services of Salem. For a fee, her company advocates on behalf of consumers to help reduce what appear to be outrageously high medical bills.
Palmer says she's taken Witkowski's case gratis, because she smells something rotten. And she's promising to get to the bottom of it.
"In my opinion, this is a racket, and [Med Trans] is making a killing," Palmer told me.
Few helicopter billing issues like these arose before February 2012. At that time, Carilion changed the air ambulance contractor it had since 1990, Air Methods, to Med Trans, another air-ambulance vendor.
Less than a year earlier, in 2011, Carilion had signed new contract with Air Methods. But Carilion canceled that contract because the hospital group "needed to expand service to meet patient needs in the region and because it was concerned about escalating costs in the future," Earnhart said.
In 2010, Earnhart added, "we were unable to respond to 300 flight requests because both helicopters were already engaged, or one of the helicopters was out of service due to maintenance and no backup was available."
More profound than the change in companies, however, was that Carilion changed business models when it switched from Air Methods to Med Trans.
Under the contract with Air Methods, the company provided pilots, two helicopters and mechanics, but Carilion operated the service and did the billing. It accepted rates insurance companies were willing to pay for helicopter transports, and Carilion assumed the financial risk.
Earnhart said the service was operating "in the black" under that model, but "we anticipated that cost increases from Air Methods was going to change that going forward. Adding a third helicopter via Air Methods would have put the program significantly in the red for many years."
The new contract, which Carilion put out to bid, was an "alternative delivery model," said Craig Yale, vice president for corporate development at Colorado-based Air Methods.
Under that, Med Trans brought in a third helicopter and assumed the billing and a lot of the financial risk.
Air Methods operates under similar models in some of the markets it serves, Yale said. He added that the amount Med Trans billed Witkowsky seems in line with what Air Methods charges in markets where it has a similar model.
Med Trans "could not accept as payment" the $5,304 reimbursement Anthem offered for Paul Witkowsky's flight last February, Yale said. In some of its markets, Air Methods has worked out agreements with insurance companies.
But Med Trans has no agreements with any insurer in Virginia, despite Carilion's expectation 17 months ago that that would happen.
"We are disappointed, and frustrated that it has taken this long for Anthem and Med Trans to reach an agreement and that patients are caught in the middle," Earnhart said.
And that's why patients flown by helicopters are getting shockingly high bills. They have no idea their insurance will cover only a small fraction of the cost. It's blowing their minds when those bills show up in the mail.
At the least, somebody ought to tell them or their loved ones what to expect before they get loaded on those helicopters.