Kaiser Permanente's blanket policy of requiring pre-authorization for medevac flights has resulted in an unexpected $13-18,000 bill for many islanders flown to mainland hospitals recently.. The insurer has denied payment for 20 flights in the past two months.
At the January 16, 2019 San Juan County Board of Health meeting, county Commissioner Rick Hughes said, "This is unacceptable and I think it's against the law. This has to stop. This makes me furious. We need to pass a law."
The discussion bounced between passionate statements of outrage by Commissioners Bill Watson and Hughes and statements by others of the realities of healthcare in 2019.
"There are other crazy things that insurance is denying, said Mark Tompkins. While noting that the denial of flight coverage is wrong, he emphasized the importance of people understanding their insurance coverage.
Strategies to rectify the situation and make sure essential medical transportation is available to islanders were discussed.
"Kaiser has changed their position. The cost is prohibitive. They are denying most of any air transport regardless of who supported it. Letting the process of review determine payment. It seems to be a corporate decision of Kaiser. I feel it is very egregious, and inappropriate," said BOH chair Dale Heisinger. "There are a number of people coming together to work on the problem. Richard Frazier is working with Kaiser Permanente with the support of Dr. Sullivan (the county Medical Program Director) and EMS and other members of the community... Frazier is very credible locally and nationally."
Superintendent for Orcas and Lopez Island Hospital Public Hospital Districts Ann Presson said, "I've also connected with Kaiser's VP of contracting. He was very understanding of our situation. I think it is a blanket policy. Felt he got that. They need to go outside of their normal protocol. The idea of being preauthorized is too time-consuming. Kaiser has been known for being very member oriented. I think they will come around. I will leverage Association of Public Hospital Districts. They are very influential. I also talked to University of Washington. They have a good relationship with Kaiser, I think they also can be helpful. My concern is the time frame. Don't want people to have to go through the appeals process."
She said the unfortunate situation is complicated by the fact people don't understand their air ambulance memberships. "It is not insurance, it is a membership. With Airlift Northwest, if you are denied, the bill comes to you. Island Air Ambulance will advocate for you and go through the appeals process. Historically they haven't gone back to the members...Island Air has hired a pretty high level individual to specifically deal with legislation that might need to be changed."
The BOH voted to write a letter to Kaiser Permanente and to the state insurance commissioner. The item will also be on the agenda for the BOH's February meeting.
Hughes said, "Someone could die if we don't take action. I couldn't live with that."