Family Hit With $97,000 Bill After Insurance Deems Baby’s Air-Ambulance Flight Not Medically Necessary

(Photo by CHARLY TRIBALLEAU/AFP via Getty Images)

Ilan Hulkower Contributor
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Sara England, the mother of four children, was hit with a $97,599 medical bill after her insurance denied covering her 3-month-old son’s air-ambulance ride during a health emergency, CBS News reported.

England’s 3-month-old previously underwent open heart surgery and started to exhibit health issues around Halloween before being brought to the attention of doctors in a local emergency room in California’s Natividad Medical Center, according to the outlet.

The doctors told England her son required swift specialized care from one of the two major hospitals in the area, CBS News reported. As they were talking, her baby was reportedly intubated before being put on a ventilator. When the child had stabilized enough for travel, doctors told her the University of California-San Francisco Medical Center could receive them, according to the outlet. England, her son and the EMT reportedly boarded a small plane to travel there. (RELATED: California’s Biggest Insurer Ending Tens Of Thousands Of Home Policies Amid Regulation, Inflation Crunch)

England’s son was diagnosed with respiratory syncytial virus (RSV) and remained at the hospital for three weeks before recovering, the outlet reported.  RSV is a common virus that infects the nose, throat, lungs and breathing pathways, causing typically minor symptoms akin to a cold, according to the National Foundation for Infectious Diseases. The aged and infants younger than 6-months-old are most at risk of experiencing more severe symptoms that require hospitalization, the Centers for Disease Control and Prevention stated. The typical period of hospitalization is “a few days,” according to the governmental agency.

England was then left with the bill as her insurance, Cigna, refused to cover any of it, CBS News reported. “I thought there must have been a mistake,” England told the outlet. “There’s no way we can pay this. Is this a real thing?”

Cigna reportedly claimed in the letter that billed England that alternative transportation could have been feasible to transport the child and therefore the airlift was not medically necessary.

“What they’re basically saying is that the parents should have opted against the advice of the physicians,” Caitlin Donovan, a National Patient Advocate Foundation spokeswoman, told CBS News. “That’s insane. I know ‘medical necessity’ is this nebulous term, but it seems like it’s becoming a catch-all for turning down patients.”