(UW Medicine/contributed photo)

(UW Medicine/contributed photo)

State’s Kaiser investigation concludes

The Office of the Insurance Commissioner for Washington State released the results of its investigation into Kaiser Permanente’s emergency air ambulance denials for San Juan County residents, and the board of health is not satisfied. The board discussed the report during its meeting on June 19.

“This problem is not fixed at all,” Commissioner Dr. John Geyman said. “I think, as a board of health, we should do a rebuttal to what I think was a totally unsatisfactory investigation by the [commissioner’s office] of Kaiser denials.”

In January, a pattern began to emerge when several Kaiser customers received payment denials for their emergency medical air ambulance evacuations off island. Kaiser started denying the flights from patients in the San Juan Islands in September 2018, according to an Island Air representative. There are two emergency air evacuation providers in the islands: AirLift Northwest and Island Air Ambulance.

According to AirLift Northwest Executive Director Chris Martin in April, her company had submitted 33 claims to Kaiser for trips it has flown since Jan. 1, and they were still waiting for determinations at that time. In January, an Island Air Ambulance representative said the company had 20 outstanding denial claims from Kaiser.

San Juan County Director of Health and Human Services Mark Tompkins shared that 14 claims denied by Kaiser remain unpaid because the commissioner’s office concluded Kaiser’s denials were valid. The commissioner’s staff has decided to take no further action on the complaints.

“I don’t have a lot more to add at this point,” Tompkins said.

Board of health commissioner chair Dale Heisinger said he was unaware that the report the county had received was the final one on the denials investigation. He noted that there was a recent conversation with the board, which he believed was going to affect the report, though the date of the report’s conclusion predated that phone call.

“So, [the investigators] came into this meeting [having] already completed their opinion. Our input in that meeting was not going to be considered in their reevaluating their conclusions,” Heisinger said. “So that was a little disturbing to me, it was disturbing to other people.”

Heisinger said that he believes the commissioner’s investigators are not medically trained and thus not qualified in determining the medical necessity of medical air ambulance evacuations.

“It’s nonmedical professionals overriding the prescription of a medical professional,” county council member Bill Watson said.

Tompkins said that the report wasn’t a complete disappointment; of the 24 total claims denied by Kaiser, six were overturned and Kaiser ultimately paid the provider because of the investigation.

“That was a significant positive step, I would say, for folks that were experiencing those bills,” Tompkins said.

Geyman surprised much of the board when he announced that Dr. Michael Sullivan, the medical program director for the county’s emergency medical services, is resigning. Tompkins noted, however, that Sullivan’s resignation is unrelated to Kaiser’s denial of claims.

The board of health isn’t done with trying to find a solution to the 14 remaining denials. Tompkins outlined the steps the county will take to resolve the situation as it nears its 10th month. He stated his intention to: work with the future medical program director and paramedics to have a thorough understanding of what emergencies necessitate an air ambulance transport; do research and address a legislative amendment that can be made to protect island residents from denials of this type; and convene the medical community to discuss transportation alternatives.

“I don’t want someone going, ‘I can’t afford $17,000 so I’m just going to drive,’” county council member Rick Hughes said. “I don’t want people to make a decision based on money that could cause more harm.”