ST. LOUIS - For nearly two years, Julie and Tim Zapor battled their insurance company, Anthem Blue Cross Blue Shield.
“We’ve spent hours and hours of our time on this for at least the last 12 months trying to get them to do the right thing,” said Julie Zapor.
The Zapors believed doing the right thing meant Anthem fully covering their $35,000 claim. Minutes after their son TJ was born, doctors at Missouri Baptist Hospital decided to airlift him to St. Louis Children’s Hospital for more intensive care.
“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,” Julie said.
Anthem denied the Zapor’s claim, ruling the air ambulance transport “wasn’t medically necessary.” It’s a familiar answer from the company. In our 2016 report, Sullivan, Missouri resident Jeannie Radford said Anthem told her the same thing when it denied her $50,000 claim.
“Ultimately I’m going to try to get them to change the policy,” said Sen. Claire McCaskill.
After our report, McCaskill took a step towards that goal by introducing the Air Ambulance Consumer Act. McCaskill says the legislation would allow states to regulate medical costs associated with air ambulance service. That’s currently barred due to the Airline Deregulation Act of 1978. It would also clarify billing costs for consumers, for a complaint hotline, and establish an advisory committee to make recommendations for the industry.
“Senator McCaskill’s proposed legislation is well-intended, certainly, but it’s taking the wrong approach,” said Carter Johnson, representative of the Save Our Air Medical Resources campaign.
SOAR is national campaign dedicated to medical services issues. SOAR believes allowing state-by-state regulations would create borders in the sky. Johnson says that’s potentially problematic, considering 48 percent of air ambulance flights in Missouri cross state borders.
"The real solution is for insurers to step up to the plate and do right by patients by covering these emergency services. At the end of the day, that’s what insurance is for,” Johnson said.
SOAR favors a different piece of legislation that would address what Johnson described as chronic under reimbursement by Medicare. She says 7 out of 10 air ambulance transports involve patients with Medicare, Medicaid, or no insurance at all.
“Since you got involved, the insurance company has decided to do the right thing and they have paid the claim in full,” said Julie.
After our interview, Fox 2/KPLR 11 contacted Anthem and requested it review the Zapors case. We’re happy to report that after five denials, the company reversed course and covered the claim in full. It’s a little victory in a battle we’ll continue to fight.