Air-Ambulance Medical Claim Denied

Sara England was putting together Ghostbusters costumes for Halloween when she noticed her baby wasn't doing well. Her 3-month-old son, Amari Vaca, had undergone open-heart surgery two months before, so she called his cardiologist, who recommended getting him checked out. 

At Natividad Medical Center in Salinas, California, doctors could see Amari was struggling to breathe and told her that he needed specialized care immediately, from whichever of two major hospitals in the region had an opening first. Amari was declining rapidly, his mother said. Doctors put a tube down his throat and used a bag to manually push air into his lungs for over an hour to keep his oxygen levels up until he was stable enough to switch to a ventilator.

According to England, late that night, when doctors said the baby was stable enough to travel, his medical team told her that a bed had opened up at the University of California-San Francisco Medical Center and that staffers there were ready to receive him.

She, her son and an EMT boarded a small plane around midnight. Ground ambulances carried them between the hospitals and airports. Amari was diagnosed with respiratory syncytial virus, or RSV, and spent three weeks in the hospital before recovering and returning home.

Then the bill came - The Patient: Amari Vaca, now 1, who was covered by a Cigna policy sponsored by his father's employer at the time. Medical Services: An 86-mile air-ambulance flight from Salinas to San Francisco.

Total Bill: $97,599. Cigna declined to cover any part of the bill.

Cigna determined that Amari's air-ambulance ride was not medically necessary. He could have taken a ground ambulance instead of a plane to cover the nearly 100 roadway miles between Salinas and San Francisco.