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. England assigned Amari’s grandparents to trick-or-treat duty with his three older siblings and headed to the local emergency room.
Once they arrived at Natividad Medical Center in Salinas, California, she said 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.
Even as they talked, 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 England that a bed had opened up at the University of California-San Francisco Medical Center and 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.
Total bill: $97,599. Cigna declined to cover any part of the bill.
What gives: Legal safeguards are in place to protect patients from big bills for some out-of-network care, including air-ambulance rides.
Medical billing experts said the No Surprises Act, a federal law enacted in 2022, could have protected Amari’s family from receiving the $97,000 “balance bill,” leaving the insurer and the air-ambulance provider to determine fair payment according to the law. But the protections apply only to care that health plans determine is “medically necessary” — and insurers get to define what that means in each case.
According to its coverage denial letter, Cigna determined that Amari’s air-ambulance ride was not medically necessary. The insurer cited its reasoning: He could have taken a ground ambulance instead of a plane to cover the nearly 100 roadway miles between Salinas and San Francisco.
“I thought there must have been a mistake,” England said. “There’s no way we can pay this. Is this a real thing?”
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