02/20/2019: "SJC Board Of Health Continues Discussion On Payments For Air Transport Concerns"
( Island Guardian photo)
The San Juan County Board of Health’s meeting on Wednesday (02-20-19) included a continued discussing of concerns on air medical transport issues related to KP (Kaiser Permanente of Washington) declining payments for air transports that have been rejected as being not medically necessary, and transport by ground ambulance would have been adequate.
Island Air Ambulance spokesman told the Board that under Group Health, from February 2017 thru September 2018, 117 flights had been paid for by Group Health with only two being denied.
In September, after KP took over providing medical insurance from Group Health, of the 24 flights made, only 7 were paid, 18 were denied, and 1 is yet to resolved.
The problem appears to result from KP deciding that flights are being made that are not necessary, even after a physician has determined that a flight is necessary, and that ground transportation could have been used.
Dr. Michaeld Sullivan, the Medical Program director for both San Juan and Orcas said that he wants to know who at KP is reviewing the flight events and making the decision that they are not necessary. He said only an experienced physician would be qualified, and he has not able to get a response from KP as who is turning the claims down that have been authorize by him, a physician with 28 years of EMS and emergency medicine.
A number of speakers explained that if authorization for a flight is not authorized and the claim is denied, it can be appealed by the submission of documentation. If the appeal is denied, then the Filing of a Complaint should be made to the state Insurance Commissioner.
The representatives of Island Air and Air Lift NW said the public should know that they never refuse to transport a patient, “we are the 911 of the air,” and they expressed concern that no one should refuse air transport that has been approved by responding physician, because of fear of being hit with a large bill.
Dr. Sullivan said he is in discussion with KP, has asked them to come up to the islands to discuss the problem and hopefully gain a better understanding that ground transport is not as readily an option as it is on the mainland. To date, KP has not scheduled a meeting.