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Photo: N/A, License: N/A, Created: 2019:11:07 10:58:57

The Kilker family in Mehoopany experienced a huge debt after an accident on their property last March. In the front, from left, are Denna and James. In the back are Ryan, Patrick and Claire.

Claire Kilker wasn’t surprised to hear from Air Methods on the evening of Jan. 16.

The company had been checking in regularly since it provided an emergency air ambulance for her son James last spring that cost over $53,000.

With Air Methods being an out-of-network provider, their health insurance company Highmark only covered around $4,000, leaving Claire and her husband Ryan with a substantial debt.

Only this phone call wasn’t to check in on the family’s progress with appealing the bill. It was to inform them that their balance had been lowered to zero.

“They said they had gone through all the channels they possibly can with the insurance company,” said Claire. She remembers the Air Methods representative on the phone noting that her family had been compliant with the company’s process.

Her first reaction was to ask for proof of their zero balance in writing.

“It just seemed surreal to get that phone call after 10 months of worrying about the bill,” she said.

Last March, James, who was two years old at the time, was playing outside with his older siblings Patrick and Denna on the family’s property in Mehoopany.

Patrick and Denna came inside to get cleaned up as Claire watched James from a window, who eventually fell face first into their pond.

The child was breathing, but unresponsive. As Claire removed his wet clothing and rushed to get him into warm water, her other son dialed 911.

Emergency responders made the call to transport James to Wilkes-Barre General Hospital through an air ambulance.

James was fine, much to the relief of his family. For months later, though, the medical cost loomed in the back of his parents’ minds.

Their appeals through Highmark were unsuccessful, so the family turned to Rep. Karen Boback’s office.

The state ultimately couldn’t help because the Kilkers’ insurance plan through Ryan’s employer runs through Medicare, but they were encouraged to speak with his employer’s human resources representative about another appeal.

The representative spent the day communicating with Highmark, Claire said, and that night, Air Methods called about the balance.

“I don’t know what was the catalyst to make this go away,” she said.

Asking the representative from Air Methods how and why the balance was dropped, she received an ambiguous answer: that it was a combination of things, but he was not an liberty to say.

An Air Methods spokesman explained general information about the company’s services in Pennsylvania, but did not speak to this individual case.

Air Methods has a “patient-centric” process in place and makes every effort to avoid balance billing, he said. First, the company reaches out through phone calls and letters to discuss the emergency and the services provided.

If a patient is in network, then they’re only responsible for insurance mandated co-pays and/or deductibles. Air Methods contacts out-of-network patients left with a balance after their initial insurance reimbursement to inform them of the next step, which is appealing to their insurance company.

“Unfortunately, insurance denies over 50 percent of these initial claims as ‘medically unnecessary,’ meaning we must partner with our patients to appeal to the health insurance company to get the emergency coverage our patients deserve,” the spokesman said. “If the health insurance company deems all appeals are over, but still has left the patient with a remaining balance, our normal practice is that, given the patient has worked with us in trying to get the health insurance company to cover their emergency care, we only bill for the insurance’s co-pay and/or deductible, which providers are required to collect.”

He said Air Methods acknowledges the stress and financial difficulties that medical bills could bring.

“Air Methods is dedicated to partnering with insurers to develop in-network agreements, so that we can work together and systematically address costs of care more effectively,” he added.

Besides increasing its number of in-network agreements with commercial health plans, he said the company has been expanding its Patient Advocacy Program, as well as working with legislatures for a “more accurate Medicaid and Medicare reimbursement model.”

Anthony Matrisciano, spokesperson for Highmark, said adjustments to a bill aren’t a decision for the insurance company, as it only administers benefits.

“We’re pleased there was a good outcome,” he said.

It was difficult after the accident for Claire to work through the trauma without remembering the financial burden.

“I wanted to be able to heal from seeing my child in such a devastating position, but every time I thought about it, it brought up this whole other anxiety,” she said. “It’s just upsetting to me that other people are dealing with this on a daily basis.”

She hopes legislators could take action.

Sen. Judith Schwank, D-Reading, has sponsored Senate Bill 822, which would provide “protection of consumers of health care coverage against surprise balance bills for emergency services and certain covered health care services.” The bill has been referred to the Baking & Insurance Committee.

Additionally, Rep. Tina Pickett, R-Towanda, has sponsored House Bill 1862, which would provide “protections for consumers receiving surprise balance bills for health care services from out-of-network providers.” As of Jan. 21, the bill has been removed from the table.