Yes, Americans pay more for healthcare than anyone else in the world. Yes, for all those trillions of dollars spent annually, we have lower life expectancy and higher infant mortality rates than other developed countries — two key metrics for judging the effectiveness of a nation’s healthcare.
But the thing that never ceases to astonish me is how needlessly cruel our system is.
I’m not just talking about the life-saving prescription drugs that can cost tens of thousands of dollars. (A month’s supply of the bone-disease drug Actimmune will run about $50,000, according to GoodRX.)
I’m talking about the small acts of greed and pettiness that make a bad situation for the sick even worse.
Rancho Palos Verdes resident Carrie Hassanzai contacted me the other day about her 18-year-old son, Ethan, who has cerebral palsy, autism, epilepsy and other serious ailments. He requires a shunt to drain fluid from his skull because of brain surgery.
“He is a severely, severely disabled child,” Hassanzai told me.
About a year ago, Ethan began vomiting and having what seemed like seizures. Hassanzai feared that her son’s shunt had become clogged — a potentially fatal complication.
She and her husband, Moe, a Los Angeles Police Department detective, rushed their son to the emergency room at Torrance Memorial Medical Center.
Hassanzai said the ER doctor on duty felt unsuited to handle the scope of Ethan’s issues. She asked where he’d had his earlier brain surgery — UCLA — and immediately contacted the Westwood facility.
“There was a pediatric neurosurgeon at UCLA, and he said they’d send an ambulance for Ethan,” Hassanzai recalled. “We didn’t know it would be an air ambulance.”
Ethan was flown 20 miles north, treated and released after two nights in UCLA’s intensive care unit.
Then came the bill for the air ambulance. A company called Reach Air Medical Services wanted $51,000 for the trip.
Anthem Blue Cross denied the claim, arguing that use of a helicopter wasn’t medically necessary. Hassanzai appealed. Months passed.
She said she received a notice from Reach this summer. If it didn’t get its $51,000, the company warned, it would sic debt collectors on the family. Hassanzai appealed once again to Anthem.
The company’s final word on the matter arrived last month. “This request is denied as not medically necessary,” Anthem reiterated.
“We don’t have the money to pay that,” Hassanzai told me.
I can appreciate Anthem’s position. There are closer hospitals that Ethan could have been transported to via ground ambulance.
But how are distressed parents supposed to know that? And what are they expected to do?
“We didn’t know if our son would live or die,” Hassanzai said. “The doctors made the decision to transport him by helicopter. Were we supposed to challenge them?”
No, of course not. How could anyone reasonably be expected to override trained medical professionals in such a situation?
Your son might be dying. Doctors say he must be flown immediately to the hospital where he’s been treated before.
There isn’t a mom or dad in the world who responds by saying, “I don’t know, couldn’t we just drive him somewhere else, somewhere we’ve never been before?”
Leslie Porras, an Anthem spokeswoman, acknowledged that “the need for transfer to another hospital and ground transportation was covered” by Ethan’s insurance.
“However, based on the review of the case and the hospital records, Mr. Hassanzai was stable in his vital signs and exam while he was in the emergency room, and when he was transported to the receiving hospital,” she said.
“In accordance with our medical necessity criteria outlined in our policy, air ambulance transportation was not medically necessary in this case and ground transportation was appropriate for his care.”
Porras noted that Reach Air Medical Services “is not contracted with Anthem” and thus “can charge whatever they choose.”
She said Ethan’s family “is entitled to pursue an additional appeal” of the denied claim with Anthem.
Hassanzai says the family pays $97 a month in health insurance premiums. And to be sure, Anthem covers most claims for a teen with very serious medical issues.
But let’s not kid ourselves. It seems like an arbitrary decision at best to deny coverage for treatment ordered by doctors in the midst of an emergency.
One wonders if the helicopter ride would have been deemed medically acceptable if Reach did have a contract with Anthem and thus a lower price could have been negotiated.
As it stands, the insurer has picked the one expense it couldn’t control and singled it out for exclusion.
Anna Blair, Reach’s vice president of service delivery, said it’s common for insurers to deny coverage for transport by air ambulance.
“They use 20/20 hindsight,” she said. “But when there’s an emergency, you have to rely on the medical professionals involved.”
Blair told me the company would reach out to Hassanzai to discuss enrolling the family in its “compassionate billing process,” which Blair said could reduce the $51,000 bill “by a tremendous amount.”
That’s great. But it shouldn’t come to this — begging for mercy from healthcare providers.
Anthem is the country’s second-largest for-profit health insurer, after UnitedHealth Group. Its net income rose 8% to $1.14 billion in the quarter ended June 30. Profit last year reached $3.75 billion.
Gail Boudreaux, Anthem’s chief executive, formerly executive vice president of UnitedHealth, received total compensation of $14.2 million last year.
“I’m flabbergasted,” Hassanzai said after being informed of Anthem’s response to my inquiries. “We all grow up being told to listen to our doctors. In that moment, we thought it was life or death for our son.”
Knowing how it would all turn out, would she have behaved differently? Would she and her husband have insisted that Ethan be driven to a closer hospital?
“If I had to do it all over again,” Hassanzai replied, “I would do the same damn thing.”
As would most people, I suspect.
UPDATE (Oct. 8, 9:50 a.m.): After the column was published, Hassanzai contacted me to say Anthem had agreed to pay the claim.