HELICOPTER

The only time I have ever been on a helicopter, I was unconscious. As I have written before, late in the evening of January 2, 2024, I experienced the most terrifying moments of my life. I had been in a local emergency room all day feeling generally crummy after briefly losing consciousness for about 5 seconds early that morning. While the emergency room team tried to figure out what was wrong with me, my heart rate spiked to over 200 beats per minute, without warning. I was awake and alert while it felt like someone hammering on my chest. I was severely short of breath, and, turning to the emergency room doctor, I weakly said “Please help me.”

He told me that the team was going to shock me. There were 6-8 people in the tiny room and my wife was taken into the hall. Quickly I felt large stickers being pressed onto my chest and back, an ascending high pitched tone filled the air, someone shouted “CLEAR” and I saw bright light and stars in my vision, while simultaneously feeling like a horse was kicking me in the chest. It was enough to thump me up from the bed for a brief second and then my breathing slowed and my heart stopped pounding. I was dazed, but otherwise o.k. I asked the doctor if what just happened to me was what I see on T.V. I was told “yes, but without the paddles these days.”

This cycle began again roughly twenty minutes later. Again I was “shocked.” Again no meds were given for sedation. I inquired about this later and they told me that “there wasn’t time.” Translation: they feared for my life.

Repeat. Third time in less than an hour. The emergency room team began calling Boston hospitals to see where an intensive care unit (ICU) bed was available. I was told that, due to my heart and lung complications from advanced muscular dystrophy, this local hospital was not equipped to handle the level of care that I currently needed. Moreover, no one could discern why my heart was spiraling out of control, and the safest path of action was to get me into Boston.

About 20 minutes later, a bed was located at Lahey Hospital, which was roughly 25 miles away and is known for their cardiac care. The hospital is just north of Boston and, at the time, had the only ICU bed open of the 5 different hospitals that were called.

At that point in time, there was no way of knowing if/when my heart was going to spike up again, and the goal was to move me and get me stabilized ASAP. I was told that if they shocked me again, they would risk permanently damaging my heart. Of course, 40 years of living with muscular dystrophy had already done that, as the heart is a muscle, and so timing was of the essence. I asked how long I would need to wait for the transport ambulance.

The emergency room doctor quietly told me that I would be traveling by air and I was going to be mobile within the next 5-10 minutes. Terror washed over me. No one takes a med flight unless the shit is getting serious. I vividly remember saying to my wife: “Please don’t leave me.”

A man rolled in with portable medical oxygen tanks, plastic tubes and a bunch of other medical stuff was placed on my stretcher in front of me. He told me: “We are going to help you breathe a little easier.” I didn’t know it then, but I was being “intubated.” This is when a tube is placed down the throat and into the trachea to keep it open and assist the flow of oxygen through a bag or a ventilator. I do not remember anything being placed down my throat as I was sedated.

My only memory is briefly being cold, the sensation of being lifted and, off in the distance (so I thought) I heard rotors of a helicopter. Somehow I knew that we were taking off.

When I awoke, I was being wheeled into a hospital room with a bunch of people around me, tubes all over the place, and things beeping. I remember the room being small, and dimly lit (though it probably was quite bright) and I remember people putting a plastic board under me as I was wrapped in a sheet loudly calling: “1, 2, 3!”…..I was being pulled from one stretcher to a hospital bed. I was propped up with a bunch of pillows, given a warm blanket and told where I was and that I would not be able to speak as I had breathing tubes in my throat, which I could certainly feel. I was told that I was stable and that it was a bit after 11PM, my wife was in the hospital and I was going to be ok as soon as they figured out what was wrong with me. I was given more sedatives through a IV in my arm and told to relax and rest. Easier said than done. All of this had happened very fast and it occurred to me that if I had not been airlifted, I could very likely have been at the gates answering a bunch of questions to see what/where the next life was going to be like. This thought brought me more terror, and I silently said a prayer of thanks to my wife, and the team of emergency room health care professionals who made the call.

My journey was just beginning, and although I didn’t know it that night, I would come even closer to death than the events that led up to the amazing Boston Med Flight Team.

Fast forward one year later. I am fully back to baseline and feeling fine. The helicopter ride cost $23,600 and my health insurance company has decided that my life is not worth that much money: they are refusing to pay the bill. I have gone through 2 levels of appeal and have been denied both times. I am currently requesting an external review, which is the next step, but I am also in touch with several state offices to see how/if they can help me. There is a lot in the news today about the state of health care in our country, and if people don’t speak up and demand change, it will never happen. I have been told, by Med Flight, that they will not come after me to pay this bill, and I asked them how they stay in business if insurance routinely denies coverage for these flights. That’s a whole other blog, but, to not get too far off the path, I am choosing today, to reprint, in full, the Anthem Health Care second level denial letter here. I wave all HIPAA rights so you can share in the words, and my disbelief that something like this, in a life-threatening situation, can be denied. If anyone out there has national press contacts, I welcome you to share this with them. Let’s shine a light on a broken system.

DATE: JANUARY 14, 2025

YOUR APPEAL:

You filed and appeal for approval of air ambulance transport, A0431-Ambulance service, conventional air services, transport, one way (rotary wing), and A0436-Rotary wing air mileage, per statute mile, by New England Life Flight on January 2, 2024, because you feel the air ambulance was medically necessary.

OUR DECISION:

We have re-reviewed your specific circumstances and health condition as documented in the appeal and clinical information provided to us by your treating physician. The reviewer is a health plan Medical Director, and MD, who is board certified and specializes in Internal Medicine. It’s their recommendation that we keep our previous coverage decision. Here’s why:

The request tells us your doctor ordered travel in a helicopter or airplane (air ambulance transport). The information we have shows you had heart and breathing problems (ventricular tachycardia). The plan critical criteria considers this transport to be medically necessary when your life is in danger and transport by ground ambulance may place you at risk. In these cases you should be taken to the closet hospital that is able to give you the care you need to reduce your risk. The nearest appropriate hospital (Lahey Hospital) was 26 miles away and less than 35 minutes by ground transport from where you were. Dispatch of aircraft to the transferring facility, air transport and ground transfers required at least 78 minutes. The records do not show going by ground may have placed you at risk. For this reason, the request is denied as not medically necessary. It may help your doctor to know we reviewed this request using the plan clinical guideline, Ambulance Services: Air and Water (CG-ANC-04)

End of letter.

This is what they said in the first appeal also, and so, in my second request, in addition to providing Anthem with a detailed transcription of the notes from the E.R. visit at the local hospital, I explained the waiting situation with regards to full ICU beds, and I asked them to look into the local ground transports to find out if they were otherwise engaged and/or provide me with how they came up with the time differential due to time of night, traffic flow etc. All semantics which allow them to deflect, duck and dodge. Well, I can play that game too.

No response to any of that. Letter #2 that you just read is pretty much the same as the first denial. Who is this mysterious board certified MD? NO ONE IS ALLOWED TO SEE THE WIZARD the health care company shouts!!!

My other favorite part of the above denial letter is the part where they state that “I felt” the helicopter to be necessary. I didn’t feel anything but fear of death. The emergency room team made the call and my wife told them to take whatever action was needed to save my life.

I will not be silent, I will not go away, and I will argue every point of this denial until I run out of options. Actually, I will fight until I run out of heart beats.

The words in the denial letter from Anthem Health might as well say: hey man, we are not going to pay $23,600. Your life isn’t worth that much.

The family yearly premium paid for by my wife (the subscriber) and her employer (Salem, NH School district) is over $25,000 per year. We, the customers, pay that much every year, along with more than 45 million other “subscribers” in the U.S. Oh, and the premiums are based upon “usage” so says the lady that comes to the school district each year to justify an annual increase in premiums while they try to squeeze more out of us with “co-pays”, “in or out of network” and “deductibles.” That’s my favorite: Pay the $25,000 but you also have to pay some more before we cover some and then fork over $20 each time you see a doctor. It’s like the mafia dreamed up a perfect system, and WE ALL GO ALONG because……we have to. Side note: if you want to buy a car, or anything, in another state….go right ahead….but you CANNOT purchase health insurance across state lines? WTF?

Second side note….for at least 20 years, the ANTHEM health building in my nearby city of Manchester, NH has had guards, gates and locked doors. It’s not a bank…..and again, I have observed this for 20+ years. Not just lately, where morons flip out and resort to violence…which IS NEVER THE ANSWER. The answer is, please listed to us, the people. We are struggling out here.

Back to the point…We ALL pay a lot, and, on denials, we are expected to simply go away….NOT ME.

Gail Boudreaux, the CEO of Elevance Health, formerly known as Anthem, was paid $20,931,081 in 2022.

Their website states that the company is a “for profit” health insurance company, and as I write this, one share of this publicly traded behemoth is $398.69.

Maybe I should have purchased stock ten years ago, waited and then sold it to pay for my medically necessary helicopter ride.

What country is this? What planet is this? Can we all agree that the current system doesn’t work and that the decision of who lives and dies should not be made by people and computers who have no idea who were are?

SEND HELP and let’s shine a light on this. I welcome your comments please.