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Air Ambulance Bidding: Good or Bad for the Critical Care Patient?


The following story comes to us from a recent article posted on the Royal Gazette Online.

Back in 2005, so the story goes, a Bermuda Air Medivac air ambulance was preparing for takeoff on the runway when the patient being transported went into his third cardiac arrest. The vice president of BAM, Eloise Bell, halted the flight, and the medical team quickly resuscitated the patient. Bell immediately called the patient’s cardiologist, who advised her that if they were to bring the patient back to the hospital, he would surely die.

These are the kind of tough calls many air ambulance operators have to make on a routine basis. With the dire warning of the cardiologist taken into consideration, Bell decided the patient should be flown on to the United States, where he could receive specialized care for his condition. Following medical treatment in the U.S., the patient lived for several more years, thanks in part to that tough call made by Ms. Bell.

That was how things worked back in the days of 2005. Today, if the same situation happened, it’s very likely that patient would have had to wait for hours while BAM competed with air ambulance companies in the U.S. to underbid eachother for the right-to-flight. Following the initial bidding process, it could have taken several more hours for an out-of-country air ambulance to arrive, depending on the aircraft’s point of departure in the U.S..

Patients in Bermuda little awareness and even less control over the bidding war being waged over them before they can get to the care they need. Unless they decide to pay for an air ambulance service out-of-pocket, their fate is left in the hands of their insurer – and ultimately, in some cases, whatever company offers to transport them for the cheapest price.

Ms. Bell from BAM says she saw the need for an air ambulance serving the islands of Bermuda back when she was a nurse. In her own first-hand experience, she witnessed people waiting up to 12 days for an air ambulance from the United States to arrive, as Bermuda was not generally considered a high priority by operators in the States. When she first attempted to start up the service, she was repeatedly told by other business people that she would never be able to get everything off the ground. Following the donation of an aircraft and the hiring of three pilots, things finally took off – pun intended. Since 2005, her company has run about 500 trips.

Unfortunately, the company is not internationally certified by the Commission on Accreditation of Medical Transport Services (CAMTS), meaning some insurance companies refuse to utilize BAM’s services. In order to get proper certification from CAMTS, the company would have to satisfy specific requirements for things like mountain travel, desert travel, over-water travel, and snake bites. They attempted to get an exception from the commission for their individual circumstances, since they operate primarily in the vicinity of Bermuda, but the request was flatly refused. They were, however, able to be accredited by an independent company who was willing to look at their specific situation. Nevertheless, many insurance companies refuse to accept this kind of independent accreditation.

Thebidding system for air ambulances began in Bermuda about two years ago. Basically, how it works for BAM is: when a patient in Bermuda requires an air medical transport, Ms. Bell receives an e-mail. As a result, she’s forced to sleep with her BlackBerry next to her head. In the middle of the night, Ms. Bell only has half an hour to respond to the e-mail. She has to reply with a bid for the transport – then it’s a waiting game. If another air ambulance company doesn’t underbid them, BAM gets the “job” and they begin the transport process.

On the other hand, if another air ambulance company presents a lower bid to the insurance company, depending on the provider, it’s likely they will get to transport the patient instead. It’s a behind-the-scenes, wheeling-and-dealing process that, it could be argued, is more concerned with how much money an insurer has to pay for the transport than the well-being of the waiting patient.

This is not to suggest that all insurers across-the-board are solely concerned with the cost of a transport and no other factors that may affect the patient’s outcome. However, it would be foolhardy to think that insurance companies in general do not consider cost factors when it comes to air medical care providers.

Ms. Bell wishes the Bermudian insurance industry would give BAM more support. “If you are President Clinton in New York, you can get to a major hospital and get a stent in within two hours,” she said. “Why do we have to wait eight hours in Bermuda because they choose to give their air ambulance flight to someone else?”

In the meantime, patients who can afford to pay for their own air ambulance flight have the advantage of faster access to specialized care. It’s a lopsided, but nevertheless true, situation that some Bermudians say is in place just in place so insurance companies can haggle over a few percentage points – with the largest expense being time.

One citizen of the Bermudas commented that she can’t believe air ambulance companies have to bid on the transport of patients who need urgent medical attention, especially when those critical patients “have paid for [the trip] ten times over” in insurance premiums. Some less reliable air ambulance operators, who may even be located in states far from Bermuda, have the opportunity to underbid other companies, including BAM, with little consequence even if they are hours late on arrival (something that has apparently happened in the past).

While specific figures are not available and the facts of specific cases are largely anecdotal, it is nevertheless theoretically possible that a patient could have to wait for an air ambulances located in a state relatively far from Bermuda to arrive in the islands, based simply on the fact that they were willing to do the job for less. Naturally, patient who is in need of an air medical transport and relying on their insurer to pay for it is, it’s safe to assume, fairly likely to be in need of critical care, where seconds – and certainly hours – can make a difference.

What do you think of the bidding system for air ambulances? Is it fine to let transport of Bermuda’s critical patients requiring specialized care in the United States go to the lowest bidder? Does the bidding system need an overhaul, or should it just be thrown out? If so, what would replace it? How should insurance providers make decisions on who to use for a transport? Please leave your comments in the area below.

Sources: Royal Gazette Online,

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