U.S. Sixth Circuit - The FindLaw 6th Circuit Court of Appeals Opinion Summaries Blog

Doctor Gets Stuck With Air Ambulance Bill

A ride in a private jet might be fun in some cases, but not if it's an air ambulance jet.

It was really not fun for a doctor who arranged a jet ambulance for his son to be transported across the country for continuing medical care. It was actually painful because the physician's insurance plan denied coverage.

In Springer v. Cleveland Clinic Employee Health Plan Total Care, it left the doctor holding the bag and a bill for $340,000.

"May Be Denied"

Springer, a Utah physician, started a fellowship at the Cleveland Clinic and applied for the employee benefit plan. The terms said it would take 15 days to process, and that claims "may be denied" during that time.

One week later, the doctor arranged for his 14-month-old son to be transported from a Utah hospital to the Cleveland Clinic by Angel Jet's air ambulance service. The child had been hospitalized since birth with multiple health conditions.

Angel Jet flew, and so did the child, but not the bill. First the company sued the health plan under the Employment Retirement Income Security Act, then Springer tried it.

Eventually the buck stopped at the Sixth Circuit Court of Appeals. Chief Judge R. Guy Cole, Jr. delivered the bad news to the doctor.

"No Reimbursement"

The chief judge emphasized with boldface type the language in the health plan, which said if "the member does not participate in the precertification process before obtaining the service there will be NO REIMBURSEMENT for the service."

The problem was, the appeals court said, it was not a medical emergency. Basically, Springer should have waited another week to complete the process.

The judge said sometimes "it's easier to seek forgiveness than seek permission." But not this time.

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