CBS News
Without Medicare Part B’s shield, patient’s family owes $81,000 for a single air-ambulance flight
Debra Prichard was a retired factory worker who was careful with her money, including what she spent on medical care, said her daughter, Alicia Wieberg. “She was the kind of person who didn’t go to the doctor for anything.”
That ended last year, when the rural Tennessee resident suffered a devastating stroke and several aneurysms. She twice was rushed from her local hospital to Vanderbilt University Medical Center in Nashville, 79 miles away, where she was treated by brain specialists. She died October 31 at age 70.
One of Prichard’s trips to the Nashville hospital was via helicopter ambulance. Wieberg said she had heard such flights could be pricey, but she didn’t realize how extraordinary the charge would be — or how her mother’s skimping on Medicare coverage could leave the family on the hook.
Then the bill came.
The Patient: Debra Prichard, who had Medicare Part A insurance before she died.
Medical Service: An air-ambulance flight to Vanderbilt University Medical Center.
Service Provider: Med-Trans Corp., a medical transportation service that is part of Global Medical Response, an industry giant backed by private equity investors. The larger company operates in all 50 states and says it has a total of 498 helicopters and airplanes.
Total Bill: $81,739.40, none of which was covered by insurance.
What Gives: Sky-high bills from air-ambulance providers have sparked complaints and federal action in recent years.
For patients with private insurance coverage, the No Surprises Act, which went into effect in 2022, bars air-ambulance companies from billing people more than they would pay if the service were considered “in-network” with their health insurers. For patients with public coverage, such as Medicare or Medicaid, the government sets payment rates at much lower levels than the companies charge.
But Prichard had opted out of the portion of Medicare that covers ambulance services.
Lisa Krantz for KFF Health News
That meant when the bill arrived less than two weeks after her death, her estate was expected to pay the full air-ambulance fee of nearly $82,000. The main assets are 12 acres of land and her home in Decherd, Tennessee, where she lived for 48 years and raised two children. The bill for a single helicopter ride could eat up roughly a third of the estate’s value, said Wieberg, who is executor.
The family’s predicament stems from the complicated nature of Medicare coverage.
Prichard was enrolled only in Medicare Part A, which is free to most Americans 65 or older. That section of the federal insurance program covers inpatient care, and it paid most of her hospital bills, her daughter said.
But Prichard declined other Medicare coverage, including Part B, which handles such things as doctor visits, outpatient treatment, and ambulance rides. Her daughter suspects she skipped that coverage to avoid the premiums most recipients pay, which currently are about $175 a month.
Loren Adler, a health economist for the Brookings Institution who studies ambulance bills, estimated the maximum charge that Medicare would have allowed for Prichard’s flight would have been less than $10,000 if she’d signed up for Part B. The patient’s share of that would have been less than $2,000. Her estate might have owed nothing if she’d also purchased supplemental “Medigap” coverage, as many Medicare members do to cover things like coinsurance, he said.
Nicole Michel, a spokesperson for Global Medical Response, the ambulance provider, agreed with Adler’s estimate that Medicare would have limited the charge for the flight to less than $10,000. But she said the federal program’s payment rates don’t cover the cost of providing air-ambulance services.
“Our patient advocacy team is actively engaged with Ms. Wieberg’s attorney to determine if there was any other applicable medical coverage on the date of service that we could bill to,” Michel wrote in an email to KFF Health News. “If not, we are fully committed to working with Ms. Wieberg, as we do with all our patients, to find an equitable solution.”
The Resolution: In mid-February, Wieberg said the company had not offered to reduce the bill.
Wieberg said she and the attorney handling her mother’s estate both contacted the company, seeking a reduction in the bill. She said she also contacted Medicare officials, filled out a form on the No Surprises Act website, and filed a complaint with Tennessee regulators who oversee ambulance services. She said she was notified Feb. 12 that the company filed a legal claim against the estate for the entire amount.
Wieberg said other health care providers, including ground ambulance services and the Vanderbilt hospital, wound up waiving several thousand dollars in unpaid fees for services they provided to Prichard that are normally covered by Medicare Part B.
But as it stands, Prichard’s estate owes about $81,740 to the air-ambulance company.
More from Bill of the Month
The Takeaway: People who are eligible for Medicare are encouraged to sign up for Part B, unless they have private health insurance through an employer or spouse.
“If someone with Medicare finds that they are having difficulty paying the Medicare Part B premiums, there are resources available to help compare Medicare coverage choices and learn about options to help pay for Medicare costs,” Meena Seshamani, director of the federal Center for Medicare, said in an email to KFF Health News.
She noted that every state offers free counseling to help people navigate Medicare.
In Tennessee, that counseling is offered by the State Health Insurance Assistance Program. Its director, Lori Galbreath, told KFF Health News she wishes more seniors would discuss their health coverage options with trained counselors like hers.
“Every Medicare recipient’s experience is different,” she said. “We can look at their different situations and give them an unbiased view of what their next best steps could be.”
Counselors advise that many people with modest incomes enroll in a Medicare Savings Program, which can cover their Part B premiums. In 2023, Tennessee residents could qualify for such assistance if they made less than $1,660 monthly as a single person or $2,239 as a married couple. Many people also could obtain help with other out-of-pocket expenses, such as copays for medical services.
Wieberg, who lives in Missouri, has been preparing the family home for sale.
She said the struggle over her mother’s air-ambulance bill makes her wonder why Medicare is split into pieces, with free coverage for inpatient care under Part A, but premiums for coverage of other crucial services under Part B.
“Anybody past the age of 70 is likely going to need both,” she said. “And so why make it a decision of what you can afford or not afford, or what you think you’re going to use or not use?”
KFF Health News (formerly known as Kaiser Health News, or KHN) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
California Gov. Gavin Newsom on Sunday vetoed a landmark bill aimed at establishing first-in-the-nation safety measures for large artificial intelligence models.
The decision is a major blow to efforts attempting to rein in the homegrown industry that is rapidly evolving with little oversight. The bill would have established some of the first regulations on large-scale AI models in the nation and paved the way for AI safety regulations across the country, supporters said.
Earlier this month, the Democratic governor told an audience at Dreamforce, an annual conference hosted by software giant Salesforce, that California must lead in regulating AI in the face of federal inaction but that the proposal “can have a chilling effect on the industry.”
The proposal, which drew fierce opposition from startups, tech giants and several Democratic House members, could have hurt the homegrown industry by establishing rigid requirements, Newsom said.
“While well-intentioned, SB 1047 does not take into account whether an AI system is deployed in high-risk environments, involves critical decision-making or the use of sensitive data,” Newsom said in a statement. “Instead, the bill applies stringent standards to even the most basic functions — so long as a large system deploys it. I do not believe this is the best approach to protecting the public from real threats posed by the technology.”
Newsom on Sunday instead announced that the state will partner with several industry experts, including AI pioneer Fei-Fei Li, to develop guardrails around powerful AI models. Li opposed the AI safety proposal.
The measure, aimed at reducing potential risks created by AI, would have required companies to test their models and publicly disclose their safety protocols to prevent the models from being manipulated to, for example, wipe out the state’s electric grid or help build chemical weapons. Experts say those scenarios could be possible in the future as the industry continues to rapidly advance. It also would have provided whistleblower protections to workers.
The legislation is among a host of bills passed by the Legislature this year to regulate AI, fight deepfakes and protect workers. State lawmakers said California must take actions this year, citing hard lessons they learned from failing to rein in social media companies when they might have had a chance.
Proponents of the measure, including Elon Musk and Anthropic, said the proposal could have injected some levels of transparency and accountability around large-scale AI models, as developers and experts say they still don’t have a full understanding of how AI models behave and why.
The bill targeted systems that require more than $100 million to build. No current AI models have hit that threshold, but some experts said that could change within the next year.
“This is because of the massive investment scale-up within the industry,” said Daniel Kokotajlo, a former OpenAI researcher who resigned in April over what he saw as the company’s disregard for AI risks. “This is a crazy amount of power to have any private company control unaccountably, and it’s also incredibly risky.”
The United States is already behind Europe in regulating AI to limit risks. The California proposal wasn’t as comprehensive as regulations in Europe, but it would have been a good first step to set guardrails around the rapidly growing technology that is raising concerns about job loss, misinformation, invasions of privacy and automation bias, supporters said.
A number of leading AI companies last year voluntarily agreed to follow safeguards set by the White House, such as testing and sharing information about their models. The California bill would have mandated AI developers to follow requirements similar to those commitments, said the measure’s supporters.
But critics, including former U.S. House Speaker Nancy Pelosi, argued that the bill would “kill California tech” and stifle innovation. It would have discouraged AI developers from investing in large models or sharing open-source software, they said.
Newsom’s decision to veto the bill marks another win in California for big tech companies and AI developers, many of whom spent the past year lobbying alongside the California Chamber of Commerce to sway the governor and lawmakers from advancing AI regulations.
Two other sweeping AI proposals, which also faced mounting opposition from the tech industry and others, died ahead of a legislative deadline last month. The bills would have required AI developers to label AI-generated content and ban discrimination from AI tools used to make employment decisions.
Some residents east of Atlanta were evacuated while others were told to shelter in place to avoid contact with a chemical plume after a fire at a chemical plant.
Rockdale County Fire Chief Marian McDaniel told reporters that a sprinkler head malfunctioned around 5 a.m. Sunday at the BioLab plant in Conyers. That caused water to mix with a water-reactive chemical, which produced a plume of chemicals. The chief said she wasn’t sure what chemicals were included.
A small roof fire was initially contained, but reignited Sunday afternoon, Sheriff Eric Levett said in a video posted on Facebook as gray smoke billowed into the sky behind him. He said authorities were trying to get the fire under control and urged people to stay away from the area.
People in the northern part of Rockdale County were ordered to evacuate and others were told to shelter in place with windows and doors closed. Sheriff’s office spokesperson Christine Nesbitt did not know the number of people evacuated.
The federal Environmental Protection Agency and the Georgia Environmental Protection Division were both on site, county Emergency Management Director Sharon Webb said. The agencies are monitoring the air “to give us more of an idea of what the plume consists of.”
McDaniel said crews were working on removing the chemical from the building, away from the water source. Once the product is contained, the situation will be assessed and officials will let residents know whether it is safe to return to their homes, she said.
An evacuation center was opened at Wolverine Gym in Covington.
Washington — Sen. JD Vance and Minnesota Gov. Tim Walz will face off on Tuesday in the first and only vice presidential debate of the cycle, as the two candidates look to prop up the Republican and Democratic tickets with fewer than 40 days until Election Day.
The debate, hosted by CBS News at the CBS Broadcast Center in New York City, will be moderated by “CBS Evening News” anchor and managing editor Norah O’Donnell and “Face the Nation” moderator and CBS News chief foreign affairs correspondent Margaret Brennan.
Here’s what to know about how the candidates are preparing for the debate:
How JD Vance is preparing for the VP debate
The Ohio Republican has been preparing for the debate for more than a month, a source directly involved told CBS News, including with “murder board” sessions with a small team that includes Vance’s wife and his advisers, along with senior Trump adviser Jason Miller.
Among Vance’s main focuses during the preparation has been studying Walz’ debate style and policy record, the source said, noting that Vance will attempt to highlight what he sees as the Minnesota governor’s left-wing views during the debate.
Vance told reporters last week that his plan is to break down what the Trump-Vance administration would do to make “life better” and connect that to policy.
“So, we’re studying up as much as we can on the issues that matter to the American people, and I’m looking forward to it,” Vance said.
House Majority Whip Tom Emmer, a Minnesota Republican, is standing in for Walz during Vance’s debate prep, four sources familiar with the preparations told CBS News. Emmer and Walz have deep roots in Minnesota and are close in age.
Emmer told ABC’s “This Week” on Sunday that he’s known Walz for decades and has spent the last month working to “get his phrases down, his mannerisms.”
“My job was to be able to play Tim Walz so JD Vance knows what he’s going to see,” Emmer said.
Getty Images
How Tim Walz is preparing for the VP debate
Walz has been preparing for the debate with a close team of advisers, a source familiar with the preparations told CBS News. Some of the people involved also helped Vice President Kamala Harris take on former President Donald Trump, among others, like a long-time aid to Walz who worked with him during his bids for governor.
For Walz, whose name recognition was until recently limited outside of Minnesota, the focus is on continuing to introduce himself to the American people, according to the source. He’ll also work to highlight Harris’ vision for the nation’s path forward.
“You’ll hear me talk like I have about things that impact Americans, making sure they have the opportunity to thrive, making sure that we’re being factual in how we talk about that,” Walz told MSNBC’s Rachel Maddow of the debate earlier this month. “And so I’m looking forward to it. I’ll work hard, that’s what I do.”
During debate prep, Transportation Secretary Pete Buttigieg is standing in for Vance, a campaign official familiar with the preparation told CBS News. The former mayor of South Bend, Indiana, also assisted Harris during her debate prep in 2020, and is close in age to Vance.
When and how to watch the presidential debate
Debate coverage on CBS News 24/7 begins at 4 p.m. ET, with the debate getting underway at 9 p.m. ET on Oct. 1.
The 90-minute debate will be streamed on CBS News 24/7 and Paramount+ across all available platforms and CBSNews.com. The debate will also be simulcast across other broadcast and cable networks.
,
,
and
contributed to this report.
California Gov. Gavin Newsom vetoes first-in-nation AI safety bill
Residents in Georgia ordered to evacuate or shelter in place after fire at chemical plant
Israeli airstrikes kill dozens across Lebanon as Hezbollah confirms a 7th top commander was killed
California Gov. Gavin Newsom vetoes first-in-nation AI safety bill