There is still no solution in sight for Kaiser Permanente customers who have had their emergency air ambulance services denied. During its regular meeting on March 20, the San Juan County Board of Health heard an update from San Juan County Health and Community Services Director Mark Tompkins.
“We have not received a response from Kaiser back to that letter,” Tompkins said regarding a letter the board sent to the insurance company on Feb. 22.
Tompkins explained that there was a meeting scheduled between Dr. Michael Sullivan, medical director for the San Juan Islands’ emergency medical services, and a Kaiser Permanente doctor scheduled for March 8, which was canceled with no indication of rescheduling. At about the same time, Tompkins continued, he received a phone call from Laura Gelwicks, a community representative for Rep. Rick Larsen.
“They’re willing to advocate on our behalf,” Tompkins said of Larsen’s office, which has contacted the state’s Insurance Commissioner Mike Kreidler regarding the issue. Tompkins said that Larsen had a meeting with Kaiser Vice President of Network Strategy John Prassar on March 25. According to an employee of Larsen, the two men did not meet personally, however, staff from both entities met to discuss the topic. Tompkins said he tried to call Prassar prior to the meeting but he didn’t want to speak to Tompkins at that time.
“[Prassar] said he’s not comfortable having additional conversations with me until that conversation occurs,” Tompkins said. “The product Kaiser covers out here does cover what they say are medically necessary emergency air transports. … The denials that have occurred to date … were not medically necessary [according to Kaiser]. So they’re continuing with that stance.”
Tompkins continued, adding that the insurance commissioner’s office has opened an investigation into the situation. He encouraged people who have denials for emergency air ambulance services from Kaiser to report them to the insurance commissioner.
“[The insurance commissioner] wants to know the complaints or else it’s not an issue,” San Juan County Councilman and board of health member Jamie Stephens said. “The issue is that [Kaiser is] arguing medical necessity, yet in the end, they’re paying. [Kaiser is concluding] it is medically necessary, and all they’re doing is adding cost and bureaucracy to the process.”
According to AirLift Northwest Executive Director Chris Martin, her company has submitted 33 claims to Kaiser for trips it has flown since Jan. 1, and they’re still waiting for determinations.
There are two emergency air evacuation providers in the islands: AirLift Northwest and Island Air Ambulance. Kaiser began denying emergency flights from patients in the San Juan Islands in September 2018, according to an Island Air representative. During a board of health meeting in January, it was stated the company had 20 outstanding denial claims from Kaiser.
Kaiser Permanente is the only insurance available to San Juan County residents unless the receive insurance through an employer or have Medicaid, and it requires preauthorization for air medical transportation. In an emergency situation, however, the board of health agreed there is not enough time for preauthorization.
“There are people out there thinking they have a $20,000–$25,000 bill hanging over their head at a time at their most vulnerable with physical or mental conditions,” Board of Health Chairmember Dale Heisinger said. “It provokes a tremendous amount of anxiety and concern. I think it’s unconscionable that this insurance carrier is generating that kind of response in patients that they’re supposed to be providing care for.”
A community forum is scheduled for 6:30–8 p.m. on April 25, at Mullis Center for Kaiser members and other people interested in discussing the ongoing problems with air ambulance insurance payments.