When Amanda Boley went into cardiac arrest last October, she was airlifted by helicopter to the nearest Level One trauma center, located 44 miles away. Unconscious and fighting for her life, she had no say in the emergency decision that saved her. But six weeks later, while still recovering, Boley was shocked to receive a bill for $65,000 after her insurance company denied coverage for the air ambulance flight.
Her insurer, Anthem, argued that she should have obtained pre-authorization for the transport, despite being unconscious at the time. Boley later recalled waking up in the hospital, intubated and restrained, realizing only then where she was. She said she could not comprehend how she was expected to secure approval for the flight while essentially clinically dead.
Experts Question Denial Logic
Patricia Kelmar, Senior Director of Health Care Campaigns for the Public Interest Research Group (PIRG), noted that Boley’s experience was not unique, though data on similar cases is scarce because insurers are not required to disclose the frequency of these denials. Kelmar said she could not imagine how pre-authorization could even be possible in a true emergency.
She suggested that artificial intelligence may increasingly play a role in these types of coverage decisions. According to Kelmar, while AI can improve efficiency, it may fail to capture the nuances of a patient’s unique medical history. She argued that human oversight is critical to ensure patients are treated fairly.
Appeals Often Overturn Denials
Boley appealed Anthem’s decision twice, but each time the insurer maintained its position that air ambulance services were subject to medical necessity reviews and required advance approval. Boley described feeling overwhelmed and devastated when she learned of the $65,000 bill, fearing she had no way to cover the cost.
She expressed relief that she had survived her medical crisis, but worried others might face the same situation. She felt that patients should be able to focus on recovering rather than battling massive medical debt, so insurance companies could protect their profits.
According to PIRG, patients who appeal often succeed, with as many as 75% of denials being reversed. However, many consumers remain unaware of how to navigate the appeals process.
