The University of Vermont Medical Center paid more than $250,000 for a hospital doctor to be flown home by air ambulance from the Dominican Republic earlier this year, according to sources.
A Florida-based medevac service sent the hospital an invoice for $536,000 for transporting the doctor, who was injured while on vacation, from the Caribbean country back to Burlington in late January.
The medical center’s CEO, Dr. John Brumsted, paid $38,135 at the time his colleague’s flight was booked, the sources said. In June, hospital officials directed that REVA, the Fort Lauderdale-based air ambulance service, receive an additional $218,116, bringing the amount paid to more than a quarter of a million dollars.
The status of the nearly $280,000 balance is unknown. The doctor who was transported told VTDigger that REVA has not sought personal payment of the balance.
Initially, top hospital officials told VTDigger they were unaware of any large air ambulance claims, but later amended their answers and acknowledged a large payment had been made. They declined to comment further, citing medical privacy. An official with the air ambulance company also declined to comment about the status of any balance due.
VTDigger is not identifying the doctor, who requested medical privacy. The doctor and other sources described the injuries as serious. The doctor said the injuries required care not available in the Dominican Republic “as soon as possible.”
The doctor confirmed to VTDigger not knowing the flight would cost more than $38,135; sources indicated the doctor and Brumsted both said they would have canceled the flight if they’d known what the REVA invoice would be. A hospital spokesperson said the doctor had to cover a portion of what the hospital paid and described the amount as “substantial.”
“We are still working out the details of this very complex situation,” the doctor said by email.
In an interview with VTDigger in November, Brumsted and hospital senior legal counsel Spencer Knapp initially said they were unaware of any large air ambulance payments made by the hospital. Medically necessary flights are a covered health care benefit for employees at the hospital, which is self-insured.
Two days after the interview, a hospital spokesperson said Brumsted and Knapp had “reflected” on the interview and wanted to provide “a more accurate answer.” They then acknowledged a large payment had recently been made.
According to sources, Brumsted signed an agreement with REVA to transport the doctor from the Dominican Republic to Burlington on Jan. 30, after receiving a “quote” for $38,135, which Brumsted thought was the full cost of the flight. Sources said Brumsted paid with his hospital American Express card. However, the contract amount apparently was only a retainer; the agreement called for charges of $122 for every air mile.
After transporting the doctor home, REVA sent the hospital an invoice dated Jan. 30 for $536,000, billing for more than 4,200 air miles. The medevac company charged for flying from its base in Fort Lauderdale to the Dominican Republic, then to Burlington and back to Fort Lauderdale, a method of billing that is standard industry practice.
Fort Lauderdale to the Dominican Republic is more than 800 miles; the Dominican Republic to Burlington is almost 1,800 miles, and the return trip to Fort Lauderdale is about 1,300 miles. (No explanation was given why REVA charged for several hundred additional miles.)
REVA bills itself as the biggest air ambulance service in North America and offers emergency and non-emergency medical transport. The company has a fleet of 19 jets, including 14 Learjets modified and “configured and staffed to resemble a self-contained critical-care unit,” according to the company’s website.
In June, after reviewing the bill, the UVM Medical Center’s Human Resources Department determined the hospital’s insurance plan typically covered medically necessary air transport to the closest hospital. Based on that opinion, the department directed the hospital’s health insurance administrator to pay $218,116 to REVA — the cost of an evacuation to Fort Lauderdale, which medical center officials determined would have been the closest U.S. hospital.
The non-profit UVM Medical Center uses Blue Cross Blue Shield as administrator of its self-insurance program. When a company is self-insured, it assumes the financial risks for health insurance benefits, typically with a third party processing the claims, sometimes carrying a “stop-loss” policy to cover claims once a certain threshold is reached.
Sources said Knapp told skeptical colleagues that Blue Cross had not raised any questions and maintained that Blue Cross had “stupidly” paid REVA the $218,116, despite the direction given by the hospital Human Resources Department. Brumsted, the sources said, was unaware of the June payment to REVA until after it was made.
Sources said Knapp told hospital officials who thought the doctor had received special treatment that UVMMC might try to recover the $218,116 “overpayment.” However, another hospital attorney, Eric Miller, said fighting REVA could be costly and the outcome uncertain, the sources said. He reportedly recommended to let “sleeping dogs lie” and hope the medevac company accepted the June check as payment in full and didn’t pursue the remaining balance.
Hospital officials, including Knapp, made clear, the sources said, that no further payments would be made to REVA after the June check was sent. Some officials expressed concern the doctor would be pursued for the rest of the bill. REVA’s website says patients are expected to pay any amount that is billed and not covered by insurance.
Some officials worried the portion of the bill not covered by insurance, if paid by the hospital, might be considered income to the doctor and subject to income tax. Sources said Knapp contended the doctor had not received a taxable benefit. There was even discussion internally of paying the doctor more salary to cover any income taxes due as a result of the flight.
In November, in a wide-ranging interview with VTDigger, Brumsted and Knapp said they were unaware of any large bills the hospital had paid for air ambulance services for any medical center employees. Brumsted said the hospital would not pay a large bill.
“Not that I know of,” Knapp said.
Brumsted said: “We wouldn’t.”
Brumsted said he had “no idea” the largest amount the hospital had paid for an employee air ambulance flight; he said he had heard of patients being charged “usurious” rates of $50,000 to $60,000 for a flight. The CEO said the medical center, a nonprofit, was considering expanding its own air ambulance services because of the “big, big, big, big problem” of high costs being charged by for-profit medevac companies.
He also said the private companies can be “not very nice” about going after balances due.
In the November interview, Knapp — who sources said has worked on the REVA case closely — also said he did not know whether the hospital’s evacuation health care benefit applied to international pickups. (Brumsted said doctors who agree to practice in a foreign country are encouraged to get an individual evacuation plan.)
Knapp said the hospital’s health insurance “covers medically necessary air transport services, and a medical necessity is determined by … well, similar to Medicare. So if it’s necessary for someone to be air transported because other transport is not available, they take you to the nearest hospital.”
At the conclusion of the discussion, Brumsted told several VTDigger reporters: “That’s an interesting line of question.”
Two days after the interview, the two hospital officials revised their answers.
“As they reflected on the interview, John and Spencer recalled that our insurance plan has, in fact, paid a portion of a very large bill submitted to it by a commercial air ambulance service that airlifted one of our insureds. Pretty recently, actually. We can’t disclose any more information about the patient or claim due to HIPAA and other privacy protections, but we wanted to make sure we provided a more accurate answer to your question,” Michael Carrese, a hospital spokesperson, said by email.
Carrese said Tuesday, after being contacted by the doctor, that the doctor had not received special treatment. The spokesperson said there had been at least two cases in past years of medevac flights for other hospital employees but did not have any details.
