Contact 2 helps resolve $35,000 insurance claim

ST. LOUIS – TJ Zapor took his first flight during his first hour on Earth. It’s a night he won’t remember and a night his parents will never forget.

“He was 30 weeks when they decided to do the emergency C-section,” said Julie Zapor.

Doctor’s at Missouri Baptist Hospital acted fast. Julie Zapor had pre-eclampsia, a potentially deadly pregnancy disorder and her liver was failing. She was placed under anesthesia and doctors induced labor.

“It was just like complete panic mode. The next thing I know they say you have a baby but he’s at Children’s Hospital, which I was very thankful for,” Zapor said.

Weighing 2 pounds 9 ounces, doctors decided TJ needed more specialized intensive care. They transported him by air ambulance to St. Louis Children’s Hospital.

“When our son is being born and it’s a life or death situation, we’re going to do whatever the doctors and educated hospital staff is telling us to do,” said Julie Zapor.

After seven weeks in the hospital, the Zapor’s brought TJ home healthy. But they soon received some sickening news. Their insurance company, Anthem Blue Cross Blue Shield, denied Arch Air Medical Services claim for the emergency transport.

“$35,000 helicopter bill for I think a three-mile flight,” said Zapor.

Anthem’s denial letter stated the flight wasn’t medically necessary. The Zapor’s were on the hook for nearly $35,000.

“They don’t just call helicopters for no reason. It’s not like these pilots are just out on joy rides. It’s because people are in critical situations that they need it,” added Zapor.

Contact 2 has investigated insurance denials on air ambulance claims for several years.

“They’re not paying the bill. It wasn’t medically necessary for me to be airlifted,” said Jeannie Radford.

Anthem denied Jeannie Radford’s $50,000 claim after she was flown from Sullivan, Missouri to St. Louis Children’s Hospital while giving birth to a premature baby.

“There is currently a big problem regarding how these services are reimbursed,” said Amanda Thayer, formerly of the Save Our Air Medical Resources Campaign.

“Seven out of 10 transports are reimbursed at rates egregiously below the cost of services in many cases," added Thayer.

The issue recently caught Senator Claire McCaskill’s attention.

“Ultimately I’m going to try to get them to change the policy,” McCaskill said.

Late last month, McCaskill sent letters to nine different air ambulance providers and insurance companies asking for documents and information on their industry and practices.

“In the meantime, we’re going to find out how broad the problem is, how many people are being impacted by the problem and as I said as it relates to the air ambulances, we’re looking at drafting legislation to address the problem,” McCaskill said.

A problem Julie and Tim Zapor no longer worry about. Contact 2’s Mike Colombo contacted Anthem and requested it take another look at the Zapor’s case.

“Since you got involved, the insurance company has decided to do the right thing and they have paid the claim in full,” Zapor said.

After two turbulent years and five appeals, the Zapor’s finally feel grounded.

“Once we got the news that it was covered thanks to your work, it was like the biggest burden was lifted off our shoulders,” she said.

In a statement, an Anthem spokesman told Fox 2’s Mike Colombo the company reviewed the Zapor’s case and, based on additional information, covered the claim in full. Anthem's change of heart is a huge victory for the Zapor's and the Contact 2 team, but this is just one case. There are so many other family's fighting appeals. Fox 2 is going to continue to follow this issue and share developments along the way.