The family of a Missouri boy who was transported by air to a hospital following a camping trip injury was left with out-of-pocket costs totaling more than $32,000, according to a St. Louis Post-Dispatch report.
Here are five things to know.
1. Ben Millheim, an 8-year-old boy who lives in South St. Louis County, fractured his skull after falling about 13 feet. The incident occurred during a 2016 camping trip with family and friends in rural Missouri.
2. After Ben fell, he experienced bleeding and seizures and was airlifted from Annapolis, Mo., to SSM Health Cardinal Glennon Children's Hospital in St. Louis, according to the report. That's a driving distance of more than 100 miles.
3. Air ambulance company Air Evac Lifeteam, part of Lewisville, Texas-based Air Medical Group Holdings, billed the ride at $44,232, according to the report, which cites documents provided by the Millheims. Air Evac Lifeteam was not in network with their coverage, which was purchased via the ACA marketplace. Their insurance company at the time, Anthem Blue Cross Blue Shield, paid $11,787 of the bill, but the family was left with medical expenses totaling $32,445.
4. Appeals with Anthem Blue Cross Blue Shield were unsuccessful, and the insurance company and air ambulance provider blame each other for the Millheims' situation, reports the St. Louis Post-Dispatch. The publication states the insurer points to the air ambulance provider's prices, and Air Evac contends the insurer is not paying enough for Ben's transport.
5. The Millheims' situation brings to light other larger issues, including balance billing. This occurs when patients receive care out of network and are billed for costs not paid to the provider by insurance. Various states have passed legislation designed to protect consumers from balance billing in certain situations, but the practice is not prohibited at the federal level, according to a report from the Commonwealth Fund. And, the St. Louis Post-Dispatch notes, even state legislation, if Missouri had it, may not have great impact on situations like the Millheims' due to how the federal government regulates air ambulances.
Read the full report here.
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