In fact, many of those air and ambulance costs claims are rejected by the insurance companies, even if the transport was called by EMTs or the hospital. It's a giant loophole that is particularly important for RVers to know about because they often find themselves in remote locations where hospitals can be few and far apart.

In RV Podcast Episode 333, we learn the startling high percentage of ambulance runs that are rejected by insurance companies and the catastrophically high costs for emergency air ambulance that also go uncovered by insurers.

You can listen to the entire podcast episode in the player below, or go about 20 minutes in to hear the interview. Or scroll down and keep reading this post for a full transcript of the interview.

Our guest is Tim Gustafson, who runs an outfit called the Medical Air Service Association (MASA) which offers a special program to cover those 100% of those ambulance costs. I met Tim a couple of weeks ago and after hearing some of the horror stories that RVers have had because of uncovered ambulance fees, I thought his information would be of great interest to RVers.

Transcript: Interview about ambulance costs related to a Medical Emergency on an RV Trip

Mike Wendland:
Joining us now to talk about these issues is Tim Gustafson. Tim is with a group called MASA, for Medical Air Services Association. I met Tim a week or so ago, and we were talking about some of the issues that RVers encounter when medical emergencies happen on the road. He had some pretty scary stories to relate to me that I in turn want to relate to you. So Tim, thank you for agreeing to come on the program and talk about some of this stuff.

Tim Gustafson:
Well Mike, thank you so much for having me.

Mike Wendland:
So let's talk a little bit about a lot of us think that if something happens on the road, we're all covered with all the different insurances. Walk through some of the scenarios that we need to understand about ambulances, whether it's emergency air ambulances or even ground ambulances.

When an air or land ambulance is called during a Medical Emergency on an RV Trip

Tim Gustafson:
Yeah. I've been an insurance broker for 16 years or so now. What that means is that I work for my clients, but I represent about 90 different insurance companies.

One of the biggest gaps that I see is ambulance coverage, by ground or by air.

Statistically, there's roughly three and a half million ground ambulance runs per year, and one out of seven is just outright denied, because it's not up to you, it's not up to the EMT to determine whether it's medically necessary. They have some heartless dorks sitting behind a desk at a home office and an insurance company to decide if it's medically necessary or not. So 14%, roughly one out of seven get denied.

Most health insurance plans do not cover emergency transportation

The denials by air ambulances are far greater than that. Denial rates are through the roof really, because air ambulances are not considered a medical expense due to the Deregulation Act of 1978. They're actually classified as a common carrier so they can just charge whatever they want whenever they want.

The Department of Insurance, Medicare, Medicaid services, any insurance company, they have about as much influence over the pricing as they do over Southwest or Delta Airlines.

Mike Wendland:
Give us an example.

The costs of an air ambulance during a Medical Emergency on an RV Trip

Tim Gustafson:
I had some great clients that were taking their RVup to Alaska in the summer of 2019. They got just North of the Washington border and the husband ended up having a heart attack.

So they called 911, which is the number you call if you're in Canada, by the way. I didn't know that. Both he and his wife were airlifted into Seattle. So it was an international air flight. He successfully had heart surgery, spent about two weeks in the hospital, and then recovered from home.

Luckily they had this MASA program, because not only did MASA pick up 100% of any out-of-pocket costs for the air ambulance, but it also paid the associated fee to have his wife be part of the escort with him. There was enough space in the helicopter to fly the wife as well.

Then once they got released from the hospital, MASA paid for them to fly commercially from Sea-Tac to Sky Harbor to get back to Arizona to fully recover. By the time they got to their house, MASA actually paid to have the RV towed from Canada all the way to their front door in Chandler, Arizona.

Mike Wendland:
Now if they had not been in that association, do you have any idea what they would have paid for all of this?

Tim Gustafson:
I think there's roughly 10,000 air ambulances and only about 15% are actually in network for any of the insurance companies, because they don't have to be. They can charge what they want. The average cost of an air ambulance is $54,000 these days, which is slightly higher than the average income for somebody nowadays. So the total bills between the transportation of the air ambulance, the cost for the RV to be towed, and the flight costs was roughly $117,000.

Air ambulance costs for a Medical Emergency on an RV Trip are often rejected

Air ambulance helicopter returning from a life-saving mission. But afterward, the costs may not be covered!

Mike Wendland:
Now I guess the thing that got my attention on this is an air ambulance is probably going to be more apt to be the case for an RVer having an emergency someplace because more often than not we're in the middle of nowhere. And that is the only way to when you have to get to the hospital in a short period of time. I always was under the assumption that when the hospital or the police on the scene said, "OK, this guy's got to be air evaced out." Who in turn does make that decision about when an air ambulance is called?

Tim Gustafson:
The doctors, the EMTs, they're always going to err on the side of caution because they don't want to have it as a lawsuit or anything like that against them. So usually it's their decision whether or not it's medically necessary.

But the majority of air ambulances are actually from one hospital to the other.

So in a typical series of events, you call 911, a ground ambulance is usually the first on the scene. They pick you up, they bring you to the nearest geographical hospital.

If that is not a Level 1 Trauma, and this is something serious as a heart attack, a stroke, a severe injury of some sort, head trauma, they're going to airlift you from one hospital to the other because of what is called the golden hour concept that says if you have a serious medical something, you have about 60 minutes to get emergency coverage or your chances of dying seriously increases.

So they airlift you from one hospital to another. Roughly 67% of all air ambulances are from hospital to hospital.

But again, it's not the doctor that decided it was medically necessary. It's not you that decides if it's medically necessary. It's the insurance company that ultimately makes that decision looking at the doctor's notes and everything like that.

Mike Wendland:
And the insurance company rejects how many of these did you say?

Tim Gustafson:
For ground ambulances, one out of every seven,  or roughly 14%. Usually again, if a ground ambulance brings you to the hospital and they decide that they're going to transport you from hospital to hospital via helicopter, they have the patient or the patient's family sign something called an ABN form, which stands for Advanced Beneficiary Notification of Nonpayment.

That makes you 100% financially responsible if that bill gets denied by the insurance company.

So what I've been coming across and a lot of my colleagues have been coming across lately is any air ambulance pretty much gets outright denied, and the reason for that denial is that a life service was provided that day.

Average ambulance costs are astronomical – especially for air ambulances

So because the insurance company covered the ground ambulance – approximately $1,900 is the average ground ambulance cost – they completely deny the $54,000 air flight. And you've already signed the form stating that you're 100% financially responsible.

Mike Wendland:
That's just an amazing thing because you would just assume … Your heart and mind is all caught in the emergency. You've got to get to the hospital, a helicopter lands, takes you to the hospital. You assume you're covered, or you go to the hospital and you have to get air evaced someplace else. They ask you to sign a form when you're under all of this stress. Can you appeal this? Do they have any luck to people when they appeal it?

Tim Gustafson:
They can appeal. A lot of times a ground ambulance, if that's been denied, I've seen success having those appealed.

But air ambulances, if you sign that ABN form, I very rarely ever see that appeal get approved.

Unfortunately to clear that debt, again, because it's not classified as a medical expense, it's classified as a common carrier, you actually have to file a full bankruptcy, not just a medical bankruptcy to clear that debt.

Mike Wendland:
So there are different RV associations that talk about emergency services. I think of the FMCA, for example. Would they cover something like this?

Tim Gustafson:
I did a lot of research on the FMCAssist program, which is their air ambulance insurance. You're solving an insurance problem with an insurance problem. This is underwritten by Chubb Insurance, a great insurance company.

But they (the FMCA) do have a lot of restrictions. You have to be using the RV, it has to be more than 75 miles away from your permanent residence, and it has to be due to an accident, accident only. Illnesses, heart attacks, strokes, anything like that do not count. It is strictly due to an accident.

They're also D plus rated by the Better Business Bureau, where MASA, again, is an association not insurance, which I think is super important. I don't think any listeners have ever heard of somebody up in arms because AAA refused to change their tire or did not get their 15% discount at a Denny's for being an AARP member. Associations say what they do and they do what they say.

How to get air and land ambulance fees covered 100% during a Medical Emergency on an RV Trip

The benefit of joining this association is that you get 100% of charges covered by ground or by air, anywhere. That is their motto, and those are the benefits. It's worldwide coverage, and they have a slew of other benefits as well.

Mike Wendland:
For our listeners to this podcast, I want to just go back and make one thing clear to them. If they're in an accident situation or they have a medical emergency, a stroke, a heart attack, and they are taken by an ambulance, a land ambulance to a hospital and that hospital is not able to effectively treat that as a Level 1 Trauma and then they are air evaced to another hospital, they could be facing $100,000 bill?

Tim Gustafson:
The biggest one I've ever seen with my own eyes was $78,000. The biggest one that I've had a client tell me about was $128,000. He was in South Dakota. He was horseback riding with his wife. His wife ended up having a stroke.

The reason for that denial, they actually picked them up in a helicopter and brought them there, and the reason for that denial is that geographically, the insurance company looked it up, there was another Level 1 Trauma 0.3 miles closer to the one that he was brought to. So the insurance company outright denied the $128,000 bill, and they denied all four appeals that he did and he ultimately wrote a check for $128,000.

Mike Wendland:
So then I guess the next question is how big of a check do we have to write to join something like MASA that covers this?

Tim Gustafson:
MASA is great coverage. If you go to my website, PeaceofMindforRVs, I give my clients an opportunity to join another association called American Senior Benefits Association. It's a nonpolitical AARP. There are absolutely no dues, and then this will reduce your premium for MASA. MASA will be $27 per month for an individual or $35  per month for a family, and a family is defined by husband, wife. They don't technically have to be married, but if they live in the same household and any legal dependents up to age 26.

Mike Wendland
I never thought of this as being an issue for RVers and I'm delighted that you agreed to come on the show and talk about this because it's something I'd never have considered. You just assume that if an ambulance picks you up and if an ambulance takes you to another hospital, no problem because it's a medical emergency.

Tim Gustafson:
Yes.

Mike Wendland:
But that's a big assumption that's not true.

Tim Gustafson:
Absolutely, and with this I just want to reiterate that there is no deductible. There's no claim forms. There's no health questions. There's no dollar limits. You call 911 just like you normally would under an emergency situation. Whatever out-of-pocket costs you get that are associated with it, you just write your member ID number on the top of the claim form or on top of the bill that you receive. You send that directly to MASA and they take care of the rest from there.

Mike Wendland:
MASA, again, stands for Medical Air Services Association. Tim Gustafson has been our guest. Thank you, Tim

Tim Gustafson:
Thank you.

More info about emergency transportation during a medical emergency on an RV Trip

The issue of emergency transportation by ambulance has a lot of complications.

Think loopholes.

One of the biggest one deals with in-network and out-of-network ambulances.

There are over 10,000 ambulance companies operating in the United States. Some companies are run by cities and states, others are run by local or national companies.

Now here's the rub: Most insurance plans only cover in-network ambulance companies. And 77% of those ambulance companies are out-of-network!

How are you to know when, in the midst of an emergency, you are loaded into an ambulance as the result of an accident or medical emergency?

You don't. Because even if you're heading to an in-network hospital, the ambulance itself could be out-of-network. That means you can be stuck with much if not all of the bill.

The MASA program Tim told us about offers coverage for ALL ambulance companies operating in the United States and other coverage areas, including Canada, Mexico, the Bahamas, Bermuda, and the Caribbean (excluding Cuba). In 99% of the time, members are left with a $0 balance after any ambulance trip.

And it doesn't have to be just on an RV trip. The coverage is true also with your personal vehicle, or if you're at home, work, school… anywhere.

After interviewing Tim, Jennifer and I signed up. For us, at least that loophole is closed and we can have a lot more peace of mind as we travel.

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