Insurance coverage denials have long troubled patients, especially when they avail of air ambulance services based on the suggestions of treating physicians. It must be noted that any patient who is in a serious medical condition cannot deny air ambulance transport surpassing the suggestion by the treating physician. The situation has caused many instances where the cost burden is ultimately transferred to the patient when the insurance company denies coverage. This time around, it was a patient who was suggested to fly to a level 1 trauma hospital in Florida. He was on a cruise at the time, and he had suffered a myocardial infarction.
The Insurance Company Had Suggested Against Using Air Ambulance Service
Insurance companies usually suggest that patients are brought to the nearest appropriate treating facility, else the coverage is denied. However, it is the insurance company that decides the appropriateness of the treating facility. In this case, the treating physician had suggested a facility in Florida whereas the insurance company had suggested a nearby hospital. Despite what the insurance provider had said, the patient was flown to Florida. This was the reason why his insurance coverage was denied. In response to this, the patient has now sued the insurance company.
The Air Ambulance Bill Came up to USD 240,000
An air ambulance bill that runs into huge amounts, such as the one received by the patient in question, can run anyone into bankruptcy. The reason cited for denial was that the advice of the insurance provider was not heeded. The hospital expenses and the land ambulance cost were covered but not the air ambulance service.
The lawsuit was filed on the 6th of October by the patient and names the insurance company for denying the coverage. He believes that the insurance provider had wrongly tried to force him to avail of a medical facility that was not in his best interest.