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Actually, I don't know what color the helicopters are, but something stinky is going on with medevac services in SW Virginia.

Folks are suddenly being charged $20,000 to over $30,000 for being medevac'd. This started when the local hospital chain (details in the links below the kosicle) changed air ambulance providers.

Dan Casey of the Roanoke Times has been covering this story since late July.

The new provider, Med-Trans, did not have a provider agreement with any Virginia insurer when it began service in February 2012 and it still doesn't. I suspect Med-Trans can't get an agreement because the insurers don't want to fork over as much money as Med-Trans wants.

It's bad enough that the hospital chain chose (was allowed to choose) a provider without first making sure the provider had coverage with the insurers, but it gets worse when we find out about the ownership of Med-Trans.

They are owned by something called Air Medical Group Holdings (AMGH) that is owned by Bain Capital Partners. It seems that Bain has found a way to extort money from people when they are most desperate.

You almost have to salute this level of greed, cynicism, and ingenuity.

AMGH seems to be following the common path of a company owned by a private equity firm. They are being loaded with debt to provide a big pay check to the owners before the company is driven into bankruptcy.

The latest article by Casey states (via Moody) that AMGH sold $200 million of junk bonds "to fund a one-time dividend to shareholders".

It's pretty obvious AMGH is circling the drain.

I some questions for anyone in Kossackstan who knows about these things. Who buys these bonds? Are they hoping to get out before the company crashes or do they believe the company will survive?

Is there some other scam in play?

Patient says air transport service took him for ride

Helicopters take medical bills into stratosphere

Copter cost still stirring up dust

Originally posted to cbgbz on Sun Sep 01, 2013 at 12:24 PM PDT.

Also republished by Virginia Kos.

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Comment Preferences

  •  Tip Jar (146+ / 0-)
    Recommended by:
    Eyesbright, Throw The Bums Out, The Nose, devis1, anana, Nebraskablue, Darwinian Detrius, Azazello, Powered Grace, badscience, worldlotus, Gustogirl, Empower Ink, Time Waits for no Woman, bastrop, newinfluence, Actbriniel, political mutt, Eddie L, Lily O Lady, kartski, FloridaSNMOM, Shippo1776, serendipityisabitch, AoT, hopi13, peacestpete, R rugosa alba, Australian2, la urracca, Anne was here, GAS, howabout, Chaddiwicker, TheMomCat, bunsk, Yosef 52, aaraujo, psnyder, Norm in Chicago, Simplify, HeyMikey, jan4insight, barbwires, kerflooey, paradise50, highacidity, Kaiju, lcrp, Bisbonian, Mentatmark, cocinero, AdamR510, belinda ridgewood, GeorgeXVIII, marleycat, No one gets out alive, revsue, kevinpdx, CorinaR, Rogneid, lostinamerica, Just Bob, Shockwave, DRo, Aaa T Tudeattack, shortgirl, Carol in San Antonio, millwood, blueoasis, Polly Syllabic, Grandma Susie, sailmaker, Zinman, Laconic Lib, exNYinTX, Ckntfld, ER Doc, ColoTim, sturunner, zerelda, Pandora, dougymi, US Blues, AnnetteK, tegrat, George3, corncam, skepticalcitizen, Massconfusion, TomP, ChocolateChris, akeitz, Josiah Bartlett, Alumbrados, Thinking Fella, Lying eyes, TexDem, pyegar, terabytes, karmsy, DeminNewJ, pat bunny, thomask, BadKitties, dotdash2u, David54, science nerd, War on Error, Brian B, markdd, RUNDOWN, MsGrin, Oaktown Girl, Kevskos, prfb, chantedor, 1BQ, Jeff Y, NJpeach, outragedinSF, ichibon, joynow, kurt, Creosote, mofembot, MartyM, Floande, cville townie, Tinfoil Hat, commonmass, pittie70, Chi, Preston S, Kristina40, Buckeye54, WheninRome, flowerfarmer, wxorknot, semiot, Paddy999, Mighty Ike, annan, gypsytoo, TracieLynn, splashy
  •  Interesting, informative, well researched diary (36+ / 0-)

    Pretty impressive for a first diary.  Congratulations!

    It's not a question of whether our founding fathers are rolling in their graves but rather of how many RPM they're clocking.

    by Eyesbright on Sun Sep 01, 2013 at 12:40:35 PM PDT

  •  looks like the bonds are paying a pretty (24+ / 0-)

    high yield - 700 bps over Libor.  they're risky, hence the yield, but with crazy low interest rates people are eager to buy debt with higher rates.  so eager, it seems, that there isn't much in the way of the sorts of covenants against loading up on more debt in the future.

    •  They would probably go to various large scale (8+ / 0-)

      institutional investors who would throw them into the sort of CDOs that were a problem before. These aren't mom and pop trying to make a buck in the market I assume. And only the large scale institutional investors can realy guarantee a pay out these days.

      If debt were a moral issue then, lacking morals, corporations could never be in debt.

      by AoT on Sun Sep 01, 2013 at 02:40:38 PM PDT

      [ Parent ]

    •  Bonds/Derivatives are first in Line (17+ / 0-)

      during a liquidation

      That doesn't help the bond holders who buy them at Par, but it is huge with distressed bond buyers who may have $0.20 on the dollar or less on them. The initial buyers pay up and lose a little and then the next round of buyers get more yield and still lose a little but the distressed buyers can make a huge profit . By then the yield is way up . They get that and then when the company goes belly up, all the assets that are liquidated goes to pay down the par value of the bond holders. That was part of the 2005 Bankruptcy Reforms.

      Then you have people who may buy the bonds but buy credit default swaps to hedge. They'll come out fine.  Very few , if any bond holder will suffer a real loss considering tax write -offs, swaps and higher yields.  

      Note: Chapter 11 reorganizations are much less likely these days as bondholders will want to push the company into liquidation. Fewer and fewer of them are lasting beyond the initial 120 days.

      These were the real big changes in the 2005 Bankruptcy Laws that went little noticed because concern was for the consumer bankruptcies. Indeed, forcing these companies out of business , causes more consumer bankruptcies.

      “ Success has a great tendency to conceal and throw a veil over the evil of men. ” — Demosthenes

      by Dburn on Sun Sep 01, 2013 at 04:10:56 PM PDT

      [ Parent ]

      •  first up is counterparty collateral (4+ / 0-)
        Recommended by:
        AoT, Ckntfld, kurt, cville townie

        on derivatives, then secured debt, then administrative and ongoing business expense, and only then unsecured debt like bonds.  

        IOW, they're pretty risky, and its why distressed debt investors can pick them up at such low prices.

        •  Bonds are first (6+ / 0-)

          It would be hard to find bonds that were unsecured or not first in line. Pre 2005 , maybe. Employee and IRS came first.

          That's why there is such a huge market in distressed bonds. The Pension Manager bought 2B worth of GMs distressed bonds for about 400K and he was the one who went to the supreme court to ask for liquidation as it was written in the 2005 Bankruptcy reforms.

          Read up on the 2005 reforms , especially bondholders. That's why they can sell these things. Otherwise private equity would have never gotten as large and pervasive as it has.

          “ Success has a great tendency to conceal and throw a veil over the evil of men. ” — Demosthenes

          by Dburn on Sun Sep 01, 2013 at 04:46:02 PM PDT

          [ Parent ]

        •  Depends on the bonds rating (7+ / 0-)

          Senior bond holders . Secured Bondholders whpo have spelled out collateral , see UCC filings.  Junior bondholders (above equity) Collateral Trust Bonds have collateral in stocks and bonds of other companies, that may be owned by the company,  etc. Your are correct that derivatives have super senior interest . Debenture bonds are the ones that have no collateral assigned.

          I(n general Bonds can be written in a custom way that gives them superior or priority interest in a filing. There is a general pecking order then there is reality. Reality these days are Bond holders usually make out unless the Govt steps in.

          Some secured creditors have dibs on specific assets. Like real estate. Sometimes creditors will write everything  on a UCC filing beyond any contracts  . This this is where arguments break out and where business bankruptcy lawyers make out huge. (They are first by the way -  the Lawyers always get paid first)

          Many times UCC filings are made on the same collateral. Then it's time to see where senior bond holders fall in and where a once senior creditor fell down the ladder because management signed contracts that gave priority to new bond holders/creditors and the first senior creditors weren't notified. Then more arguments break out. Shouting , screaming, back biting, scratching firings, buildings crumbling and all other kinds of nasty shit. Cha Ching as the BK Lawyers egg it on and bang out those billable hours.

          Generally Bonds aren't purchased without derivatives these days. That's why the bond holders almost had GM Liquidated before Obama stepped in.

          As a  side note : The bond holders were screaming "The sanctity of the contract is being violated" as the union contracts were being torn up.

           

          “ Success has a great tendency to conceal and throw a veil over the evil of men. ” — Demosthenes

          by Dburn on Sun Sep 01, 2013 at 05:19:20 PM PDT

          [ Parent ]

    •  I hope these junk bond investors (0+ / 0-)

      lose their shirts, and maybe their pants too.

  •  This kind of predatory investment strategy (35+ / 0-)

    is a reflection of the nature and character of the people implementing it.

    It's cynical and it's soulless and it's evil.

    The place was utterly dark—the oubliette, as I suppose, of their accursed convent.

    by bastrop on Sun Sep 01, 2013 at 02:04:45 PM PDT

  •  People don't buy the bonds if they believe the (4+ / 0-)

    company will fail. They buy them for the yield with the expectation that the amount of debt will diminish over time, as cash flow pays down the debt, and the debt will be repaid by an IPO, or a new buyer. Institutions buy these bonds, not Aunt Jane, and they certainly don't think the company is going down the drain when they buy the bonds.

    A very small number of private equity funds buy distressed companies and try to sell the pieces. That's a very different model than Bain Capital, or most other private equity funds. To make the standard PE model work takes a lot of debt. Distressed companies can't sell any debt so the financing needs to be all equity and that doesn't fit the standard PE model.

    "let's talk about that"

    by VClib on Sun Sep 01, 2013 at 02:10:08 PM PDT

  •  You should see how high ambulance bills (9+ / 0-)

    have gotten in the past ten years.  Like just in the truck and no flying involved.

    •  In rural areas this is worrisome (34+ / 0-)

      Out here, there are 2 of these companies and you have to pay a yearly subscription to both in order to be covered. Even if you have health insurance it's not likely to cover the entire $40,000 for your trip to an out-of-county facility.

      It's $50/yr for one and $65/yr for the AMGH subsidiary. If you are in an accident or really sick, you don't know who will be called so you'd better join them both. Our local hospital is cutting the number of beds and more and more people are flown out of county. So you will owe up to about $40,000 to the medivac company if you don't buy their membership. (Household income avg $30,000/yr in this rural county.)

      My question - why are we forced to purchase 2 memberships instead of having one membership which covers whichever organization comes or our local providers and LE just pick one and only use that one. This is pretty much something that you will probably never use, and if you do need it, it's not likely to be more than once in your lifetime.

      So I'm just wondering, if AMGH decides to put a 3rd player in this market, can they then charge everyone another $65/yr for that membership?

      There is definitely something fishy going on here and it really needs to be looked into by some real investigative journalist. This is also exhibit A of how "free market" and "competition" in health care is idiotic if not criminal.

      •  My parents live five minutes from the hospital (26+ / 0-)

        and that's if you are driving slowly and hit the three short stop lights on the way.

        The cost of an ambulance ride from their house to the hospital is about $700.

        I live 15 minutes in normal traffic from the my house to the closest hospital; and in 2007 I needed to go to the hospital in an ambulance.  It cost $50.  Now, it costs closer to $350 and you can't ask the ambulance to take you to the hospital of your choice.

        I do not know what is going on, but I do know that there are plenty of people in this country - particularly in this day and age - who would be very hard pressed to come up with those $350-$700 amounts of money.

        •  That's outrageous for sure. (15+ / 0-)

          $700 is a lot of money, but out here you really and truly are at risk of med-evac and people wonder if they'll have to to mortgage their home, or dip into retirement fund for a $40,000 med-evac bill. Or declare bankruptcy. $115 per year doesn't sound like much, but I do know some people who just have a hard time getting by already. That fact that you're forced to buy both galls me. Competition nearly DOUBLES the cost of this for rural consumers.

          •  Well declaring bankruptcy most likely won't (6+ / 0-)

            be an option for much longer (assuming it still is) as you can bet that CONgress will make medical debt non-dischargable.  Most likely as part of a "grand bargain" in exchange for not raising the Social Security and Medicare eligibility ages.

            You have watched Faux News, now lose 2d10 SAN.

            by Throw The Bums Out on Sun Sep 01, 2013 at 04:15:08 PM PDT

            [ Parent ]

          •  Absolutely true. (11+ / 0-)

            I commented on the ground travel only because there is something so askew about the whole ambulance system now that it is, I think, really scary even if you are going to a hospital five minutes away.

            $40,000 is more than a lot of people's homes would be worth if they owned them in places like West Virginia - AND I happen to believe that if you are critically ill it is enough not to ALSO contemplate losing your home or your and your family's financial future - because let's not forget that these for profit healthcare people and even the government will go after your relatives for money that they feel they are owed.

            It is a TERRIBLE situation.

            There was a time when we just rescued people and saved them because it was the right thing to do.

            I remember the debates back in the 90's about rescuing hikers and people insisting that the costs of those rescues should be paid for by the hikers and I remember thinking that that was a BAD slippery slope.

            The worst part about the current situation is that people can't even decide in the heat of the moment whether or not they want to burden their families or themselves with those kinds of debts.  I don't think that that is a choice that anyone should have to make in dire straights, but shit, if I was near death and likely to die even if I was going to be flown to a better facility, I actually might tell the helicopter not to take me away for the sake of my loved ones' financial future.

            Of course, I believe in SINGLE PAYER, but who cares about me anyway?  No one does and I get it that that is what our country is about these days.

          •  Oh and another thing... (5+ / 0-)

            Even here on Daily Kos there is a pretty strong contingent of people who believe that the answer to the questions of the universe is that everyone in the world should move to an urban center.  They are on crack and unrealistic because they don't understand what that means on so many levels, but there are a lot of people in America who have ZERO sympathy or understanding about why inhabiting rural areas is on many levels a necessary and good thing for our society and economy.

            A lot of those people have no awareness about how much more expensive their lives would be than they already are if we were to move everyone into cities - not to mention the fact that they'd likely have to do without food grown in this country.

            Med-Evac is based on mileage these days and that is not a good thing - it seems "fair" to an idiot with no understanding of the importance of a diversified economy, but those idiots are only shooting themselves in the foot in the short and long run.

          •  My mom's 10 minute ride was $950 in Utah (3+ / 0-)
            Recommended by:
            chantedor, joynow, Eyesbright

            About 10 people showed up.  It was weird

            It's difficult to be happy knowing so many suffer. We must unite.

            by War on Error on Sun Sep 01, 2013 at 09:45:22 PM PDT

            [ Parent ]

        •  If the item for sale is saving your life, (7+ / 0-)

          the market price is everything you and your family have got.

          Government and laws are the agreement we all make to secure everyone's freedom.

          by Simplify on Sun Sep 01, 2013 at 03:42:16 PM PDT

          [ Parent ]

        •  It certainly varies a lot by state (5+ / 0-)

          Subscriptions are illegal in NY. You can go to any hospital you choose. Rates are set by law. The Centers of Medicare and Medicaid Services (CMS) has a set compensation schedule for ambulance transport.

          It is definitely expensive, but not out of the realm of reasonableness, I think. A single fully equipped ALS ambulance will run upwards of $250k with ongoing costs for labor, fuel, and restocking of used equipment and drugs (which expire), not to mention the overhead for administrative work and ongoing training.

          To tweet or not to tweet. I tweet therefore I am.

          by RadicalParrot on Sun Sep 01, 2013 at 03:50:05 PM PDT

          [ Parent ]

          •  My mother's last trip to the "real" hospital (8+ / 0-)

            45 miles and not 5 minutes away was about $1,250.

            The hospital five minutes away is where you go to die when you have a critical ailment which has happened to her three times there.  So, that's the other "great" thing about the choices in that region because if you are scared that you might not be able to afford the longer trip, you might make a critical decision that could end your life.

            We are fortunate enough not to have to take the financial calculation into the equation, but that town is mostly poor and the people there do take that into consideration which is sad and scary.  Particularly since I can tell you that from our experience if some of the first important events had been treated at the other hospital 45 miles away, my mother might not have had the massive stroke she did and may well have had treatment that would have prevented the brain damage and problems that she lives with today.

            She's a much more expensive Medicare patient than she might have been.  Of course, the Obama Administration says that the medical community is doing "too many expensive tests" and that's the problem - ha - if the medical community had actually done the tests they should have - MRIs with neurologists looking at the results somewhere during the seven years that she was having significant problems - she would be far more self sufficient and probably not brain damaged as she is now.  But they didn't want to test and they wanted to write her off.  So now Medicare pays for nursing, seizure medications, neurologists, hospital stays, and all kinds of shit that a prescription for a blood thinner probably would have prevented - she had a blood clot in her brain building for years that no one found.

            Isn't that awesome?

            •  Sorry to hear that (2+ / 0-)
              Recommended by:
              ColoTim, Dianna

              Where do you think the fault lies? Was it the doctors who wouldn't order the tests, or were they hamstrung by Medicare?

              To tweet or not to tweet. I tweet therefore I am.

              by RadicalParrot on Sun Sep 01, 2013 at 05:12:39 PM PDT

              [ Parent ]

              •  The doctors who did not move her along to (5+ / 0-)

                the hospital that could have done the tests and the doctors who wrote her off as "old" even though she is not really old - and a system that is increasingly putting pressure on docs and healthcare providers to cut down on testing.

                Less and less of our healthcare system is being driven by science.  More and more is being directed by payment whether it is private insurers, government or a person's bank account.  The ACA hasn't really changed that for the average person.  It has helped with people already diagnosed with critical diseases, but it isn't going to help prevention the way that it should.  The Medicare cuts within ACA also deeply affected my Mother and other people who are in her situation.  Those cuts started rolling out early this year.

                I've worked with the healthcare industry for nearly 20 years now and I can tell you that a lot of the wonkery in ACA and the really piss-poor law writing is going to start to become problematic in fairly short order - within the next five years or so.  But it will take the next 20 or so for the studies to be completed and for people to have "science-based" evidence to once again prove that private health insurance and withholding treatment is bad for public health and the economy.  I'll be closer to dead or dead by then, though. I hope for the best for future generations in the quest to get this thing back into the zone of "health" for everyone.

      •  I know someone in a rural area here in Northern (18+ / 0-)

        California who refused to get on the helicopter because of this expense. Another family was charged for the helicopter after it transported their dead teenager from a traffic accident scene because the hospital wanted her organs.

        They are disgusting.

        "Pulling together is the aim of despotism and tyranny. Free men pull in all kinds of directions.” --Lord Vetinari

        by voracious on Sun Sep 01, 2013 at 04:29:37 PM PDT

        [ Parent ]

  •  Wow... this resonates on so many levels... (20+ / 0-)

    I'm a former resident of the New River Valley, who knows a little bit about how they used to do things there back in the day because my husband was a respiratory therapist who was on Carilion's pediatric transport team, and now is a professional helicopter pilot.

    Back in the day most transports done by the transport team were by ground ambulance, not air. He did both, but air transports were only done when medically necessary or when transporting a critical patient to a medical center for treatment not available in the NRV--the medical center opened while we were there--or in Roanoke (I remember them flying critically ill preemies to Duke for example).  Oh, and when the weather cooperated which it often didn't in the NRV and Roanoke Valley.  So he complained more often about the uncomfortable ground ambulance rides through the mountains.

    He left respiratory therapy to go back to what he used to do in the military, and what still he loves a whole lot more than working in the hospital... fly helicopters. But most of the money, and 15 years ago most of the jobs too were in the offshore oil industry. EMS flying is some of the most dangerous flying there is. And flying in SWVA is extremely risky. We did quite a bit of recreational flying in the area and a perfect day could become a really dangerous one in those mountains.  Mountain obscuration, wind shear, dramatic changes in summer air density, even freak off-season snow and ice (Bluefield!!!) were something we dealt with routinely. I had and still have a lot of respect for the pilots who fly EMS especially in an area like SWVA.

    He actually interviewed for a job with Air Methods (Carilion's previous air med contractor) but the pay was so ridiculously low there was no way we could afford to move back to SWVA even though we miss it greatly.

    So I wonder with all the years and the new contractor:

    --are pilots under any more pressure to fly in dangerous conditions? Even when transporting medically non-critical (revenue generating) patients?

    --are they paying better salaries than they did back in the day (I see they pay hefty sign on and anniversary bonuses almost like Carilion used to pay new RTs and RNs back in the day... but nothing about what their BASE SALARY is.  Is Carilion directly funding those bonuses?

    --are they short changing maintenance and/or overworking pilots like Med-Trans is accused of in this California case? BTW, that has happened elsewhere in the helicopter industry esp. among companies that are trying to "maximize profits."  Air transport (whether fixed or rotor wing) is highly cost intensive and there aren't many areas in which you can cut costs without cutting back on safety, breaking laws/regulations, or both.

    It is extremely expensive to operate helicopters BTW. But the fees they are charging for a flight from Radford to Roanoke sounds high. Apparently Anthem (one of the insurers discussed in one of the articles) agrees.  Their allowable fee sounds more in line with the costs I've heard to operate aircraft. But I'm not the professional... I'm just married to one.

    And wow, the Radford professor profiled on one of these articles was my MA thesis advisor at Radford.  In fact, he is the person who convinced me to go there over another school. I was just wondering the other day how he was doing, now that I'm in the middle of writing my dissertation. :-(

  •  right (23+ / 0-)

    This is really a good scoop here, thank you.
    I live in an isolated part of the desert borderlands and the nearest good hospital is about 225 miles away. The helicopter cost has been around 20 grand for a while.
    Two anecdotes- an old cowboy I know had a heart attack and took the copter ride from his remote ranch up to Midland. I asked, "How the hell are you ever goin to pay that?" He replied, "Well I ain't, they can't squeeze blood out of a turnip".
    A couple years ago I cut off a finger working in my shop. The little clinic here said I would have to go to Midland to see an orthopedic doctor and have it amputated. I had the presence of mind, all doped up as I was, to ask how much the ride would cost "$23,000".
    I replied "Fuck that" and wrapped up my hand in a t shirt and had a friend drive me up there.
    Hope other readers do some digging on this relevant story, and thanks again.

    I buy and sell well trained riding mules and American Mammoth Jack Stock.

    by old mule on Sun Sep 01, 2013 at 03:14:10 PM PDT

    •  IIRC, these bonds are rated fairly poorly; (2+ / 0-)
      Recommended by:
      jan4insight, akeitz

      the Moody's report said that, because there isn't much competition they have a strong market position but, OTOH, they have a lot of worthless receivables.

      •  Medical debt is one of the few categories that (3+ / 0-)
        Recommended by:
        jan4insight, DRo, Betty Pinson

        you can still default on with little punishment. If these sort fo bonds become more popular I'd expectthat to change. But the history of debt suggests that government have generally tended toward finding a way to get people into debt as a method of control, so I'd expect no less from ours given how far it's strayed from citizens' control.

        If debt were a moral issue then, lacking morals, corporations could never be in debt.

        by AoT on Sun Sep 01, 2013 at 03:28:48 PM PDT

        [ Parent ]

        •  Still hits your credit rating (2+ / 0-)
          Recommended by:
          AoT, Eyesbright

          for a long time.  There were some bills proposed to eliminate medical debts from the credit score but they went nowhere.

          Democrats give you the Bill of Rights; Republicans sell you a bill of goods!

          by barbwires on Sun Sep 01, 2013 at 03:54:16 PM PDT

          [ Parent ]

        •  Well, if the GOP gets control of Congress (2+ / 0-)
          Recommended by:
          chantedor, AoT

          I'm sure they can arrange a new Bill that allows Bain and its bloodsucking helicopter service to ding your pay and Social Security Checks.

          This won't stop until no one but the 1% has any assets left in America.

          It's difficult to be happy knowing so many suffer. We must unite.

          by War on Error on Sun Sep 01, 2013 at 09:50:41 PM PDT

          [ Parent ]

    •  Wow, I bet this is happening all over (5+ / 0-)

      The usual corporate welfare queens are all lined up for the non-emergency "revenue-generation" trips. Paging Lily Tomlin . . .

    •  I talked to my husband the pilot... (13+ / 0-)

      Flight time between Radford and Roanoke, VA is around 20 minutes if that.  It's a bit further by ground but both are on interstate highways, and unless getting to the enhanced services available in Roanoke vs. Radford in 20 minutes vs. 45 by ground really will make the difference between life and death, in more cases I remember them transporting cases much more often by ground, not air. New River Valley is a bonafide medical center which the old Radford hospital wasn't before they opened the new facility in 2000 I think. And it may be even more of one now than it was back then.

      Now some of the places in the mountains are remote without direct roads into either Roanoke or Radford, and air EMS is certainly necessary in that region.

      But I talked to my husband the pilot (who knows what companies actually charge for helicopter services, plus what it actually costs to operate an aircraft which isn't cheap) and he was floored they were charging that much for a short hop, even fully staffed with medical personnel and such.

      BTW, when I told him that Carilion switched from Air Methods to Med-Trans he couldn't believe it. Med-Trans apparently has a bad reputation among pilots. He compared them to a local offshore operator here in LA known for doing things on the cheap, but the comparison would be lost on anyone not in the industry.  But he said he knows several former pilots who have had bad experiences with the company.

      Another thing to keep in mind.  Under their old contract, Carilion supplied all the medical staff.  That was certainly true when my husband was on transport team.  He was a Carilion employee.  But Med-Trans' model generally involves their staffing the ENTIRE transport team.  Not just the pilot, aircraft, maintenance crew and maintenance of the aircraft, but also the medical personnel on board.  So if this is true and the medical personnel is working for Med-Trans and not Carilion, there is even MORE pressure to do non-necessary transports. Plus MORE room for profit on the backs of said personnel.  There is pressure on the ENTIRE team, not just the pilot, to not only transport non-necessary cases, but also transport in less than ideal weather or safety conditions.

      My husband said you couldn't pay him enough to work for Med-Trans. If their reputation among pilots is as bad as he says, no wonder why they have to bribe them pay such large sign-on bonuses.

      •  Roadkill Profits, It's So Bain (1+ / 0-)
        Recommended by:
        pittie70

        It's difficult to be happy knowing so many suffer. We must unite.

        by War on Error on Sun Sep 01, 2013 at 09:52:30 PM PDT

        [ Parent ]

      •  Down here at 79830 there was a medical (0+ / 0-)

        aircraft crash that killed patient, pilot and nurses, and a friend was being taken by chopper to san Angelo early this year and the thing crashed! He was strapped on to a gurney and survived but he was really upset, it was an emergency in the first place and that made it worse.
        Not sure what company owned the aircraft but I could find out.

        I buy and sell well trained riding mules and American Mammoth Jack Stock.

        by old mule on Mon Sep 02, 2013 at 10:32:07 AM PDT

        [ Parent ]

  •  ...keep 'em coming... (4+ / 0-)
    Recommended by:
    belinda ridgewood, DRo, Shockwave, akeitz
    Welcome from the DK Partners & Mentors Team. If you have any questions about how to participate here, you can learn more at the Knowledge Base or from the New Diarists Resources Diaries. Diaries labeled "Open Thread" are also great places to ask. We look forward to your contributions.

    Ignorance is bliss only for the ignorant. The rest of us must suffer the consequences. -7.38; -3.44

    by paradise50 on Sun Sep 01, 2013 at 03:53:18 PM PDT

  •  Redford is only 50 miles from Roanoke Memorial (9+ / 0-)

    The 1st article talks about a guy with a stroke that was airlifted 50 miles away.

    50 miles can probably be covered in 45 minutes by a regular ambulance.

    These helicopter was chasing fares.  Ambulance services should be public operations not private.  Like fire departments.

    Daily Kos an oasis of truth. Truth that leads to action.

    by Shockwave on Sun Sep 01, 2013 at 05:25:38 PM PDT

    •  Absolutely right, make them like a fire department (3+ / 0-)
      Recommended by:
      Shockwave, akeitz, WheninRome

      Some services should be public, and this is one of them.

      Carbon dioxide in the atmosphere is now 400ppm. That is "Climate Cluster Chaos". (hat tip to JeffW for CCC)

      by Zinman on Sun Sep 01, 2013 at 06:16:21 PM PDT

      [ Parent ]

    •  I was surprised he was airlifted too... (3+ / 0-)
      Recommended by:
      joynow, cville townie, Eyesbright

      Shockwave, I lived there from 1998-2001 while I was in grad school. My husband worked at both hospitals. He commuted every day from Radford to Roanoke before they opened the New River Medical Center.  It's a mountainous stretch of interstate, particularly between Blacksburg and Salem, but it's still interstate and unless the weather is bad it is around a 45 minute trek.  Faster if you are driving an ambulance I'm sure.  You are absolutely correct, they probably did not need to airlift Dr. W. from Radford to Roanoke. Here's the main reason why. The New River Medical Center (where he was initially taken) is not right in Radford.  It is outside of town on the other side of Exit 109 which is the northern Radford exit closer to Roanoke. It takes about 10-12 minutes to get to the NRMC from the Radford University campus if I remember correctly. But depending on what side of town Dr. W. lives on, it might have taken the same amount of time to get on the interstate there and take him directly to Roanoke by ground ambulance from his house rather than taking him past the exit to New River Medical Center, getting him loaded on and secured in the aircraft, and then lifting him to Roanoke. Then they have to get him out of the aircraft. I dare say that it might have even been a wash timewise.  At most they saved 5-10 minutes? I know that time is of the essence when dealing with a stroke patient but I'm really not sure they saved any time at all.

      •  Unless weather was a factor... (4+ / 0-)
        Recommended by:
        Shockwave, chantedor, joynow, Eyesbright

        I re-read the article and his stroke was in February. SWVA driving weather isn't as rough as places further north but when the weather is nasty the interstate between Radford and Roanoke can be quite treacherous. If the interstate was in bad shape then yes, I can see airlifting. BUT weather is FAR more likely to prevent AIR transports in that area than ground. It is a tricky area to fly year round, but it is especially challenging in the winter. You have to fly over at least some mountains to get directly from Radford to Roanoke. So if the weather wasn't bad enough to prevent flying the interstate was probably ok.

    •  Oh, you haven't heard the latest GOP dream (2+ / 0-)
      Recommended by:
      Shockwave, annan

      Around the country there is talk of charging citizens FEES to belong to Fire and Police services.  If you don't pay the annual fee, your not covered.

      Funny.  I thought property taxes paid the fees?

      It's difficult to be happy knowing so many suffer. We must unite.

      by War on Error on Sun Sep 01, 2013 at 09:53:52 PM PDT

      [ Parent ]

      •  WoE - in some rural communities (1+ / 0-)
        Recommended by:
        War on Error

        fire service has been provided using this model for decades. The service is typically provided by a neighboring, larger city.  The annual fee is typically $100 or less, but if you don't pay and your house is on fire they will let it burn to the ground. There was a diary about this a few years ago when one homeowner had not paid the annual $75 fee and the fire department came to the scene to be sure the people were safe and that the fire didn't spread to other structures. But the firemen watched the house burn to the ground.

        "let's talk about that"

        by VClib on Mon Sep 02, 2013 at 04:07:41 PM PDT

        [ Parent ]

  •  This could explain a recent occurrence here (2+ / 0-)
    Recommended by:
    joynow, Eyesbright

    An elderly friend of the family, a man who is not poor by any means and who has the ZIP code to prove it, recently needed to go the hospital.  He lives about four miles from the biggest hospital complex in Boston, and right near the highway leading there.  So it could be a ten minute ambulance drive with the lights on.  Maybe a bit more because of city traffic and the like, but it's a pretty easy trip.

    And how did he get picked up?  In a chopper.  Right in a densely-populated neighborhood of stores and apartments.  Why?  It didn't make sense.  But if the hospital has made a deal with the chopper service, they might be sending them where they aren't really needed.

    I understand why they need a helicopter for a serious illness on Nantucket, whose tiny hospital can't handle the most serious stuff.  But it's hardly an improvement over a ten-minute drive.  I don't know how the bill is being handled (he presumably has Medicare and some supplementary plan) but it small fishy.

  •  Virginia State Trooper provide life flights for (5+ / 0-)

    for FREE

    Had Med-Flight, the Virginia State Police Aviation Unit, been used, the Kings would not be facing a transport charge. Its services are free.

    The Kings, like many other area residents, said they were unaware of the organization. The Virginia State Police Aviation Unit was established Jan. 1, 1984, with Med-Flight II beginning operations in Abingdon in 1987.

    Other bases are in Richmond and Lynchburg.
    Sgt. J.W. Ratliff is the aviation based supervisor for the Abingdon location. His unit covers a 60-mile radius of Abingdon.

    According to him, the State Police provides the helicopter, pilot and building. The Wellmont Health Care System furnishes the medical crew (nurse and paramedic) at no charge.

    Wellmont, Ratliff said, also donates $700,000 yearly to cover medical crew salaries, equipment and supplies.

    “We are here to provide a service,” the sergeant stated. “If folks call, we will come.”

    The issue of time, Ratcliff said, is often a major factor in emergencies. The helicopter service that can be at the scene the fastest is usually the one called, Sgt. Ratliff stated

    What's not to hate about Bain Capital?

    Sadly, helicopter life flight services not owned by Bain are also bilking people who need life saving care.

    It's difficult to be happy knowing so many suffer. We must unite.

    by War on Error on Sun Sep 01, 2013 at 09:41:41 PM PDT

    •  There is quite a bit of service overlap, yes! (2+ / 0-)
      Recommended by:
      War on Error, Eyesbright

      Abingdon is almost 100 miles from Radford and even further still from Roanoke. So it is a bit far away for some of the people profiled in the Roanoke Times articles.  Their radius would probably include up to Wytheville and the I-77/I-81 interchange which is pretty much considered the very outer edge of the NRV region. Back when my husband interviewed for Air Methods (Carilion's old EMS provider) he met with them at the Mountain Empire airfield which is down past Wytheville and into this area served by the VA State Police out of Abingdon. But Med-Trans isn't based there now--their aircraft are in Radford, Roanoke and at the new base in Smith Mountain Lake.

      Lexington isn't terribly far away from Roanoke to the north and if they also provide services within a 100 mile radius probably serves the northern suburbs, including Smith Mountain Lake.

      And plans are in place to permanently move that base to Lexington where they will definitely be competing with the VA State Police!!!

      But it appears that within the New River Valley proper (Blacksburg/Christianburg/Radford) Med-Trans might be the only game in town. Or at least the one that will certainly get there the fastest.

      I did look on Med-Trans' website though and it appears they have several additional bases along the I-81 corridor down through SWVA into the Tri-Cities and into Knoxville, TN. (I did a search within 200 miles of 24141 which is Radford's zip code.) One in particular is in Marion, VA, which serves a mountainous region but also isn't far at all from Abingdon.  So it appears that at least in a good part  the VA side of this region, and particularly in the more remote areas of the extreme southwest portion of the state, they are indeed competing with the free services offered by the VA State Police.

  •  Interesting diary, but (1+ / 0-)
    Recommended by:
    joynow

    when my dad was medevac'd by helicopter in Florida almost a decade ago, the bill was $20,000 then, so I don't think these prices sound that unusual. I remember my parents being in shock over the bill, and also that Medicare didn't cover that high of an amount and they had to cover several thousand dollars of it out of their own pocket.

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