WKYCs Monica Robins submitted the following questions to Air Methods.

Here is the company

response:

Number of helicopters
Air Methods has more than 450 air medical helicopters and airplanes, with two aircrafts serving
the Cleveland market.

Type of helicopters (single or dual engine)

Air Methods fleet features both single and dual-engine helicopters. We currently only fly dual-
engine helicopters (Airbus EC135) in Cleveland, and there are currently no plans to change over
to single-engine aircraft in this region.

Where are they based

Air Methods operates more than 300 bases, serving 48 states and Haiti, with two bases in
Cleveland. The two bases are located in Medina and Middlefield, Ohio.

Type of medical staff on board/# of pilots

Each base is staffed with highly-trained air medical professionals, including flight nurses, flight
paramedics, mechanics and pilots, in service 24 hours a day, seven days a week. Our clinical
crew and aviation team undergo annual training and validation on the operations of each unit so
safety is always leading the way. Every flight is staffed with an EMS pilot, flight nurse and flight
medic.

How many flights per year

In 2016, Air Methods provided lifesaving care to more than 70,000 patients nationwide. In
addition, we cared for hundreds of patients in the past year in the greater Cleveland metro area.

Average flight distance

Flight distance is based on location of the scene call and distance between the referring facility
and the receiving facility.

Average cost of maintenance for one helicopter

The companys air medical fleet is one of the most modern in the industry, and the cost of a
helicopter is only one of the several substantial investments required to maintain access to our
emergent services. Were an airborne ICU ready to deploy 24 hours a day, 7 days a week, 365
days a year. That requires our state-of-the-art aircrafts, highly trained clinicians, EMS pilots and
mechanics, facilities and other support. In addition, each aircraft is equipped night vision
goggles, satellite trackers and GPS systems. We provide annual training for each member of our
clinical crew and validation on the operations of each unit so safety is always leading the way.

Average salary for pilots and medical staff on board

Air Methods provides competitive compensation and comprehensive benefits. Our pilots are
represented by the OPEIU Local 109 union, and compensation is guided by the union
agreement.

Average reimbursement per flight for Medicaid patient (what is state limit for reimbursement)
 In many states, Medicaid covers less than half of the cost for a transport. While Medicaid
reimbursements vary by state, some states are reimbursing as low as 1/25 of Medicare.
Pennsylvania and Utah Medicaid, for example, reimburses only $200 per air medical transport.
For comparison, the average cost of fuel alone is $450 for the average transport. In Ohio, the
urban base rate is $3,339.97.

Average reimbursement per flight for Medicare patient (what is Medicare limit for
reimbursement)
The average Medicare reimbursement is about 50% of actual transport costs. In Ohio, Medicare
reimbursements averaged $4,137 per transport in 2016.

How many Medicaid vs. single payer flights each year?

Roughly 70% of our transports are patients who have either Medicare, Medicaid, some other
government insurance coverage, or are uninsured, so we are being under-reimbursed on 7 out
of 10 transports.

What is payment protocol for patient who has no insurance?

We care for those in need regardless of their ability to pay. After the emergency is over, our
team of patient advocates work with our patients to help them navigate the complex and often
frustrating process of seeking fair reimbursement from insurance companies. We have a long-
established charity care program in place to support patients who need further financial
assistance.

How are medical decisions made regarding when helicopter is utilized? (is there a checklist to
follow?)
Access to Trauma I and Trauma II facilities within 60 minutes is critical to ensure positive
outcomes for patients who suffer from many significant medical emergencies, and our mission is
first and foremost to preserve emergency air medical service for all communities around the
country to communities and people whose lives depend on it. Were ready to deploy 24/7/365,
and the crew only responds when called upon by a first responder or physician. And we truly
believe that everyone deserves access to lifesaving care regardless of their ability to pay.

Are patients/families ever given option of whether or not they want air medical transport?
While patients may refuse air medical transport, this rarely happens because we are only called
when there is a medical necessity. Its important to understand that Air Methods only responds
to emergency transports called in by an attending physician or first responder that believes air
medical services are a necessity to improve the patients outcome or in many cases to save the
patients life. Our number one priority is to transport the patient as quickly and safely as
possible to the closest trauma center that can address their medical needs and potentially save
their lives, regardless of their ability to pay.

Are patients/families told of cost beforehand?

Our patients are primarily individuals suffering a serious cardiac event, stroke, or trauma. For
example, in 2016 alone, Air Methods transported more than 10,000 patients experiencing a
cardiac event. During these emergent situations, the crew should be focused on making medical
decisions on behalf of the patient. Whats more important for patients to know beforehand is
their insurance plan and what it covers. Insurance companies must be willing to reimburse for
 emergency air medical services. Unfortunately, some highly-profitable insurance companies play
a major role by placing the financial burden on patients through increasing insurance premiums
and reductions of coverage. After the emergency is over, our team of patient advocates work
with our patients to help them navigate the complex and often frustrating process of seeking
fair reimbursement from insurance companies. In addition, we have a long-established charity
care program in place to support patients who need further financial assistance.

Who actually does billing? hospital/supplier?

This varies. In Cleveland, Air Methods reaches out to patients in the weeks following their
transport to offer help navigating the complex process of seeking reimbursement from
insurance companies. Our Clinical Appeals Team (CAT), which consists of over 40 nurses and
paramedics, from across the country, write letters of appeal on behalf of our patients to assist
with the resolution of any remaining balances.

How often is patient sent to collection because of failure to pay bill?

These are very rare occurrences. Air Methods takes very seriously its commitment to helping
those patients with financial hardship, and we have a long-established charity care process in
place to resolve such patient accounts. We recommend that our patients work with us to
understand their options.

Can a Metropolitan/urban area like Cleveland do without air transport?

No. In Cleveland, hundreds of patients need our lifesaving services every year, and 30% of the
U.S. population relies on air medical transport for access to Level I or Level II trauma centers for
time-sensitive trauma injuries in trauma, time is critical in managing injuries and improving
outcomes. Without air medical transport, these people literally have no way to get to trauma
centers within that critical window. Were essentially an airborne ICU, and we save lives every
day. We also believe that everyone deserves access to lifesaving care.

Should State regulate air ambulance pricing? Why or why not?

No, we do not think this is an effective solution to the problem of balance billing because it
would not address the core issue. We believe there are two important solutions that would
reduce the financial burden on patients, while preserving access to air medical services across
the country. First and foremost, we must fix the drastically low reimbursements from Medicare
and Medicaid services. We strongly support the proposed federal legislation that would resolve
the Medicare reimbursement shortfall by updating reimbursement rates. Second, insurance
companies must be willing to reimburse for emergency air medical services. Unfortunately,
some highly-profitable insurance companies play a major role by placing the financial burden on
patients through increasing insurance premiums and reductions of coverage. As a responsible
provider, we are working toward long-term and meaningful solutions and we continue to try to
build collaborative partnerships with insurers who share our goal of putting the patient first and
recognize the value of our lifesaving services.

What is easiest way to lower the cost of air ambulance?

Our charges are comparable to average charges by other non-hospital affiliated air medical
service providers. The fundamental problem is that current reimbursement rates by Medicare,
Medicaid and some private insurance fall woefully short of what it actually costs for us to carry
our air medical transports. Roughly 70% of our transports are patients who have either
Medicare, Medicaid, some other government insurance coverage, or are uninsured; we are
 under-reimbursed on 7 out of 10 transports. At the same time, while most private insurers pay
at or near our billed charges, there are some private insurers who are setting rates that are far
below our true costs.

We believe there are two important solutions that would reduce the financial burden on
patients, while preserving access to air medical services across the country. First and foremost,
we must fix the drastically low reimbursements from Medicare and Medicaid services. We
strongly support the proposed federal legislation that would resolve the Medicare
reimbursement shortfall by updating reimbursement rates.

Second, insurance companies must be willing to reimburse for emergency air medical services.
Unfortunately, some highly-profitable insurance companies play a major role by placing the
financial burden on patients through increasing insurance premiums and reductions of
coverage.

As a responsible provider, we are working toward long-term and meaningful solutions and we
continue to try to build collaborative partnerships with insurers who share our goal of putting
the patient first and recognize the value of our lifesaving services.

Could you elaborate Air Methods program for $50/year that coverage helicopter services for
patient?
Air Methods Advantage provides you and your family the security of knowing that if there is a
need for a loved one to be transported via air ambulance, Air Methods will accept your health
insurance payment as full payment in advance for any medically necessary transport. That could
save you thousands of dollars for just a single transport. Most health insurance carriers will pay
for at least a portion of a medically necessary air medical transport, but the individual is still
often faced with paying for the remainder, which can amount to thousands of dollars. With Air
Methods Advantage, the once-yearly membership payment assures that the individual and
other covered family members will not have to pay anything over and above the amount paid
by their health insurance carrier for a medically necessary transport performed by Air Methods.
Air Methods Advantage members can take advantage of their program membership anywhere
that Air Methods or its subsidiaries are licensed to perform medically necessary transports.