The recent denials of many medevac flights by Kaiser Permanente, followed by its withdrawal as the only option for health insurance in San Juan County starting in 2020, poses a serious crisis to all residents of the San Juan islands that is not yet resolved.
Repeated requests by Dr. Michael Sullivan, San Juan County EMS Medical Program Director, to meet with his physician counterpart at Kaiser have been unsuccessful in clarifying the reasons and process for these denials. It appears that this is just one more example of a for-profit insurer trying to rein in costs on the backs of patients at their most vulnerable time—a medical or surgical emergency requiring immediate air transport to the mainland for specialized care.
We are told that another insurer, LifeWise, may fill the void left by Kaiser’s departure in 2020. They are now being vetted for their coverage and clinical review practices by the head of the state Office of Insurance Commissioner, Michael Kreidler, in an effort to avoid future problems of this kind.
The issues here are basic and important. Whatever insurer is involved, they must not deny any emergency medevac flights that have been called for by physicians and paramedics on the ground on any of our islands. Any delays can be fatal for patients so involved. In our rural islands, taking the ferry is not a safe option to get to the mainland for emergency care. The costs of medevac flights often reach $20,000 or more, so that some patients may elect to avoid the risk of receiving such high bills without assurance of coverage by their insurer, even to rejecting life-saving flights. Moreover, if residents believe that medevac denials will continue in the future, they may leave our islands altogether, posing a serious economic challenge to our island communities.
Despite these challenges, there is good news. We have two excellent medevac carriers, both very economical, safe, and highly experienced—Island Air for fixed wing transport and Airlift Northwest for helicopter transport. All of our County residents should have membership in both ($39 a year per household for Island Air and $79 a year for Airlift Northwest), either of which will try to help with appeals should a future insurer deny coverage of the full costs of a medevac flight. Their websites for applications are: www.islandairambulance and www.uwmedicine.org/airliftnw/aircare.
[Editor's note: While it is important to have the subscriptions to the two medevac carriers, please note that these are not insurance policies. They will cover your out-of-pocket costs that are left after your insurer pays. If your insurer does not pay, the memberships do not kick in. They do help with appeals especially Island Air who has hired insurance experts to help.]
The San Juan County Board of Health is tracking this problem and trying to develop a coalition of parties protecting Islanders from the risks of denial of coverage of medevac services in our islands, where such services can be a matter of life or death. We can, and must get to a better time when we can all expect and receive insurance coverage of emergency medevac flights to the mainland for care.
John Geyman, M.D.
Professor emeritus of family medicine,
University of Washington