Family Battles Insurer Over Rejected $60k Claim
TL/DR –
Kelly and Chris Calero were billed nearly $60,000 for an air ambulance that transported their son, Ethan, during a medical emergency. Their insurance company, Anthem Blue Cross Blue Shield, initially denied their claim, stating that it was unnecessary for Ethan to be flown to the hospital. After nearly a year and a half of dispute, the insurance company agreed to process the claim once Steve On Your Side intervened and the hospital provided additional medical information.
Parents Battle with Insurance Over $60,000 Air Ambulance Bill
Parents Kelly and Chris Calero faced a billing crisis when their insurance provider, Anthem Blue Cross Blue Shield, initially refused to cover tens of thousands of dollars in medical expenses following their son’s emergency medical situation.
In the midst of the RSV outbreak in December 2022, the Caleros immediately sought medical help for their son Ethan at Children’s Hospital South when he began experiencing breathing difficulties. Sadly, his condition worsened and doctors decided to airlift him to the Aurora-based main campus of Children’s Hospital, a 24-mile journey.
The medical situation was so grave that they had no choice but to airlift Ethan as the right ground ambulance would take six hours to arrive. After being flown to Aurora, Ethan recovered successfully. However, despite the critical nature of Ethan’s situation, Anthem Blue Cross Blue Shield initially declined to cover the nearly $60,000 bill from air ambulance provider, Reach Air.
The Caleros appealed the denial twice, but each time their appeal was rejected. They even obtained a letter of medical necessity from Children’s Hospital but their case remained unresolved, putting their plans to purchase a house on hold.
Several other families in similar situations have also had their air ambulance claims denied. A California family’s $97,000 air ambulance claim was denied despite a doctor’s order for an air transfer. Meanwhile, many insurance providers, including Anthem, have been pushing back against the costs of these flights.
Due to a surge in insurance providers denying air ambulance bills, the National Association of EMS Physicians (NAEMSP) issued a letter in February addressing this issue. Also, there are calls for the definition of medical necessity to be changed, requiring insurance companies to cover claims if a licensed doctor deems transport medically necessary.
Following an inquiry about Ethan Calero’s claim by Steve On Your Side, Anthem Blue Cross Blue Shield stated that the air ambulance company didn’t initially provide all necessary medical information. However, after Children’s Hospital Colorado supplied additional information, the claim was approved. The Caleros’ long-standing battle ended when Anthem agreed to process the claim.
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