ARI SHAPIRO, HOST:
In rural areas, specialty medical care can take hours to reach by car, so people who need emergency care often rely on flights - air ambulances. Montana Public Radio's Corin Cates-Carney brings us this story on the cost of bridging the gap between rural America and advanced medical care.
CORIN CATES-CARNEY, BYLINE: Butte, Mont., is an old mining town tucked away in the southwest corner of the state - population about 34,000. The remote mountains and wildlife make it a beautiful place for the locals to live, but like a lot of rural America, advanced medical care is far away. They were close to 3,000 air ambulance flights in Montana in 2014. That year, Butte resident Amy Thompson was on a flight with her 2-month-old daughter, Isla.
AMY THOMPSON: I could still close my eyes and - sorry - they - you know, they did such wonderful care of her, and they tried to care for me. But in that moment, I was so afraid if I closed my eyes that that would be my last vision of her.
CATES-CARNEY: Thompson curled up among the medical bags in the back of the fixed-wing plane. Isla had a failing heart. The closest hospital that could help her was 600 miles away. Seattle Children's Hospital saved Isla's life. Her family's health insurance took care of all the cost beyond her deductible except for that critical air ambulance ride to Seattle. The way the Thompsons read their insurance plan, they thought any emergency medical transportation was covered. But it turns out, the ambulance company was out of their network, and they got billed $56,000.
THOMPSON: And here's the flight that ultimately saved Isla's life by getting her to where she needs to be, yet it's going to put us potentially in a financial ruin or at least kill our future dreams as a family.
CATES-CARNEY: When a patient needs an air ambulance, the first priority is getting them the care they need as fast as possible, so patients don't always know who is going to pick them up or if the ambulance is an in-network provider. That can lead to huge bills. Jesse Laslovich is the legal counsel for Montana's insurance commissioner.
JESSE LASLOVICH: Of all the complaints we've received, not one person was uninsured. And they're frustrated as heck that because they're insured, they're still getting $50,000-balance bills.
CATES-CARNEY: States can regulate some medical aspects of their ambulances, but federal laws prevent states from limiting aviation rates, routes and services. Air ambulance companies are now offering membership programs as protection from big bills. For an annual fee of about 60 to $100, a patient faces no cost if they use that company's services. But Laslovich says that doesn't always work; a patient doesn't always know who's going to pick them up. He says patients are totally at the mercy of air ambulance companies.
LASLOVICH: You want to know what my personal opinion is about what the problem is? It's money.
CATES-CARNEY: But the president of the International Association of Air Medical Services, Rick Sherlock, says there's a lack of understanding about the actual costs of running an air ambulance business.
RICK SHERLOCK: So those cost-drivers are there to maintain readiness, to respond 24 hours a day, seven days a week, 365 days of year.
CATES-CARNEY: He says some air ambulance companies remain out of insurance networks because they can't always reach in-network deals with insurance companies that allow them to stay profitable.
SHERLOCK: In situations where there may be only one or two insurance options in an area, it's harder and harder to negotiate on a level playing field.
CATES-CARNEY: Amy Thompson ended up not having to pay but only after a lot of hassle. Once her family talked to a lawyer, the air ambulance company worked with her insurance company and waived the bill. Her daughter, Isla, turned 2 years old in November. She's a healthy, big, blue-eyed child now, but at times, her mom still worries.
THOMPSON: Nobody takes a life flight for a joyride. And I guess for me, it's not that we didn't feel like some sense of responsibility for paying anything at all. It's just, there's something ethically wrong that these companies are profiteering, essentially, off of people's worst moments in their lives.
CATES-CARNEY: A Montana interim legislative committee is currently investigating air ambulance companies' wide range of pricing within the state. Maryland is taking on a similar investigation. But in North Dakota, an air ambulance company is suing the state for adding regulations on the industry. For NPR News, I'm Corin Cates-Carney in Helena, Mont.
SHAPIRO: This story is part of a reporting partnership of NPR, Montana Public Radio and Kaiser Health News.