Wednesday, November 11, 2009


A patient will have adverse reactions due to an increase in altitude

If you are flying in a pressurized airplane most cabin pressures will be set to 8,000 ft. or below. The body does not change dramatically at this elevation. Think of all the people living in Denver at an altitude of 5,280.

 Luxury is important

It blows me away how many air ambulance companies sell their Beech Jets, Lear Jets, or Citations based on luxury. When you are in the back of an ambulance, you don’t care if the seats next to you have custom embroidery with leather stitching. You’re hoping that the guy watching your vital signs knows what the heck he is doing. A jet may sounds sexy, but medical transportations are not.

 I want a doctor onboard

Doctors and nurses both operate in extremely controlled environments with a large amount of resources. Nurses are important because they know the in’s and out’s of managing a patient once admitted. Paramedics are extremely valuable because they are comfortable with packaging patients up, using only what is available, and making the best out of a difficult situation. Doctors on the other hand are good at fixing. The patient does not need to be cured in-flight, they need to get to their destination safe and effectively.

 Bigger is better

I love all these websites that have Bombardier Challengers and Gulfstreams with red crosses photo-shopped in.  Point is, bigger is not better…bigger is more expensive. It would be like you got in a motor vehicle accident and requested a stretch Hummer limo (with a hot tub in it) to take you to the hospital versus an ambulance. Unless you are going across the country, it is more than likely you do not even need a jet.

 Medicare/Medicaid will cover my air ambulance trip

You have to determine medical necessity and then transport to the closest facility that has the capability to meet that level of care. Unfortunately, Medicare/Medicaid have a very limited scope to what they will cover.

 There is 1 leading air ambulance company

In actuality, most air ambulances are similar in size. Some have newer, bigger airplanes (which you will pay for) and some have mid-sized to small airplanes. The providers that are out there are all surprisingly similar. The important aspect is who you trust, who is located close to the transferring/receiving facility, who is timely, and who will do a good job.

 I see a whole bunch of accreditation (i.e. CAMTS), so they must know what they are doing

I do not want to take away from a future blog where I have the privilege of writing about the ridiculousness of accredited bodies and how they result in higher costs for the patients with no added benefits. However, for just a short blurb, a company can have a million accreditations, but the only ones that matter are that provider's state accreditation (so each plane becomes certified just like an ambulance), and the FAA’s. The more money an air ambulance company throws at becoming accredited by an outside body, the more money the patient has to pay to fly. Insert derogatory word + CAMTS here....

Tuesday, October 27, 2009

Why should case managers use fixed-wing air ambulances?

I felt that the last blog entry was a little negative as I was trying to point out the excessive costs brokering has put on the air ambulance industry. This blog will be dedicated to more of a positive a productive note as to why you should use an air ambulance company for a long distance medical transport.

  • Over the range of 200 miles, airplanes are much more economical than both ground and helicopter medical transports
  • By having 2-3 air ambulances that are trustworthy, reliable, and reputable, an air ambulance provider can significantly decrease the overall workload of a case manager
  • Depending on the patient’s medical condition, speed can be a necessity. You may not need a Citation X to get you across the country in 1 hour, but shaving a 12-hour road trip on a stretcher to 2 hours in an airplane can significantly help. How long would you like to be in the back of an ambulance?
  • Helicopter transports are notoriously expensive, slow, and rough. The patient will have a much smoother ride in an airplane
  • Major airlines do not have the medical setup for intensive care situations
  • You are guaranteed professional trained medical personnel if you go with someone that has state accreditation
  • It is one more resource that a case manager or social worker can have available to them

Sunday, October 18, 2009

Why are fixed wing air ambulance transfers so expensive? Let me tell you how the patients are getting taken advantage of!

I am a firm believer that every individual has the inherent right to start a business, charge for a service, and make a profit. It is the backbone of our economy. The question to any entrepreneurial business is simple, what service will you provide? In the air ambulance business, service is divided into 2 main categories: 

1)   Air Ambulance Providers – The aircraft carrier that holds a Part 135 certificate, is certified by the health department in their respected state, and holds any other accreditations that somehow raises their own superiority and ego

2)  Brokers – Marketing agents that act as air ambulance providers, incorporate a referral fee into their quote, dump their profits back into marketing, and dry up the pocket books of the patients while sipping Mai Tai’s at their desk. In other words, brokers are liaisons between the providers and case managers and they incorporate thousands of dollars into their referral fee.

I was on a trip recently with a patient that we will call Jane. Jane was going home for hospice care to live out her last days with her family. As with any trip, 50% of the work in the back goes into talking with the family, making sure they are cool, calm, collected, and comfortable.  After a 2-hour trip, they started discussing the challenges of coming up with the money for the flight. They had maxed out their only credit card and then turned to their church for the remaining amount. This was something they needed to have accomplished ahead of time because most air ambulance flights are paid up-front.

I almost fell out of my chair when I saw the $17,000 check this needy family handed over. The trip had a come from a broker who made it sound like he was facilitator. Worst yet, he made the air ambulance provider sign a waiver stating they would represent themselves as the referring company (which I am not even sure is legal).

Guess what the air ambulance provider charged? $9,100. That means the broker, aka…that fat dude in a trailer park with a phone, just hosed Jane and her family out of $8,000. Will insurance cover it? NO!

The challenge of any air ambulance provider is how to compete in this type of environment. A true provider has airplane maintenance, staff, fuel, hangar, insurance, and a small amount of profit to incorporate into their trips. The broker has marketing, their phone bill, and Hawaiian shirts to charge for. So what happens? The providers then start brokering trips.

So all of the sudden, you have all these air ambulance providers referring (aka brokering) trips out to other providers, and brokers brokering trips. Now everyone is brokering everything – and then you have overly inflated charges that are making the entire family walk with a permanent limp. So there you are, expensive air ambulance trips.

So if there is a single case manager or family member reading this – Do your research and get as many quotes as possible! Do not look at the top ranked companies in the search results; they are most likely people with big marketing budgets, who most likely will not even do anything more than make a phone call.

How to spot a broker:

·      Say they have a hundred, if not thousands of airplanes in their fleet

·      If you type in your city and a company pops up saying ‘Tampa Air Ambulance’. Every broker has a listing in every city and will claim to be from that city.

·      If they say they have multiple locations. Most providers have 2 locations at best

·      The website has generic pictures with nothing specific to their individual airplane

·      They answer the phoneair ambulance’. Ya… no kidding, if I call Dell are they going to answer ‘computers’?

·      They do not know much about airplanes outside of them talking about ‘Cessna’s and Piper’s and Jet’s…oh my…

·      If they have to get you on a conference call

·      They sound like a used car salesman

·      They are expensive