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I worked at a company which was doing medical billing for ambulances among other things. Essentially, the bills are always inflated so when the settlement come
by pshirshov 3mo ago
I worked at a company which was doing medical billing for ambulances among other things.
Essentially, the bills are always inflated so when the settlement comes the providers get 20..50%. The crucial procedure is so called "medical coding" where medical notes (sometimes - scrawled on paper with a pencil) are being turned into bills - and that's where additional codes are getting added and more expensive codes are selected. There are books and guidelines on how to do the coding and some automated logic which "fixes" filled forms to bump the amounts a bit.
If the insurance (less frequently - the patient) pays more - that's just a bonus.
Billing itself gets a small fraction of the bill usually amounting to $20..50, they don't profit from inflated bills directly but the clients would select you on the basis of average settlements. Dispatchers also get little fractions. Things are very different when it comes to helicopter ambulances, where the bill could easily get to hundreds of thousands and everyone involved gets a lot. In fact, all the operators prefer to work with helicopters because of that, everyone involved references ground operations as "crap" or so.
Can't say for whole industry but that's what I've seen at one particular place working with several providers/dispatcher companies.
From what I can remember about the ground reality, a $12K bill would mean that they expected to actually get $3..4K.
A typical ground bill for some particular region the company operated at was settled at $500..$2K while an average helicopter bill was smth around $200K if I remember correctly, with spikes up to $500K.
- Ntrails 3mo ago> an average helicopter bill was smth around $200K if I remember correctly, with spikes up to $500K. Those numbers made me blanch somewhat! Having been in a helicopter (aka Air Ambulance) in the UK, all of which operate as charities iirc, I was curious about their costs. > The average cost of a helicopter mission is £4,748* and the average cost of a critical care car or rapid response vehicle mission is £2,054*[1]. https://www.airambulancesuk.org/about-us/facts/ https://www.airambulancesuk.org/about-us/facts/ eesh
- gosub100 3mo agoThere are stories where the air ambulance sues patients who are still in ICU because getting paid depends on being first in line to file the lawsuit.
- pshirshov 3mo agoPersonally, I've never seen anything like this. Usually it's billing company who sues, not providers dierctly - again, from my experience.
- ano-ther 3mo agoThose are more sane numbers (unless you go by helicopter across the US). Also found this intriguing in your source: > London’s Air Ambulance crew made history in 1993 by performing the world’s first successful pre-hospital open-heart surgery at the roadside.
- pshirshov 3mo agoIn the UK maybe, but in the US you should expect higher bills for _ground_ transport. Like literally, the linked story is about $12K bill for short distance ground transportation not involving any complex procedures. The cases I vaguely remember did include long lists of medical codes.
- closewith 3mo agoI tried to find the asterisk there to see the details, but could not. FWIW I think that HEMS cost is significantly under costed, as the London HEMS H135s run about £2,500 per flight hour on direct flight costs alone, so I suspect the £4,748 figure is referring to that alone. I think a closer estimate is probably total annual operational costs divided by total shouts, (£18 MM / 2,000) or about £9,000 per shout. Even that's an under costing, as the clinical personnel, equipment, and liability is shouldered by the NHS. A pure costing is probably closer to 2-3X that per clinical flight. Still an order of magnitude less than the commercial US operators.
- Ntrails 3mo ago> I think a closer estimate is probably total annual operational costs divided by total shouts, (£18 MM / 2,000) or about £9,000 per shout. That's a more useful estimate than merely the flight costs, agree - though the fixed operation costs don't change much in an 1800 vs a 2100 callout scenario. > Still an order of magnitude less than the commercial US operators. It's wild!
- anonym29 3mo ago$500k? There entire helicopters you can just buy outright for less money than that. Does the $500k ride come with the helicopter itself included in the purchase?
- pshirshov 3mo agoI do vaguely remember seeing some bills with such figures. I've been literally developing various OCR and medical coding crap to process the cases and I've seen plenty of real cases. Some cases had eye-popping bills attached, yes. The $500K spike was some sort of a highway accident response, can't recall any additional details apart from some serious head/brain trauma. Keep in mind that everything gets significantly inflated, x2 multiplier is guaranteed, x5 is likely, x10 is not uncommon. Again, from what I can remember. Also keep in mind that billed != settled. If I recall correct, that bill was settled at something around $55K. That was many years ago.
- alistairSH 3mo agoUh, a new Bell 407 is north of $4 million and that's before it's equipped for medical flights. You aren't buying one of these for $500k used, at least not one that's air worthy. Eurocopter EC135 are a bit cheaper, but not by much.
- thisislife2 3mo ago-> https://www.globalair.com/aircraft-for-sale/helicopters https://www.globalair.com/aircraft-for-sale/helicopters
- pshirshov 3mo agoThere are many options very well over $1M. The 1975 one for 475K is unlikely to be used for medical transportation. But you don't have to believe my story, you are totally entitled to consider that pure fantasy.