Imagine you’re stuck in this horrible situation: while driving on the job you are seriously injured many miles from a hospital. When an ambulance finally arrives, the EMTs decide you need to be transported to the nearest medical facility by helicopter.

If you are unconscious the decision is made for you, and you are airlifted to a hospital. But if you are awake, you know that under a law the Legislature passed to supposedly “protect” injured workers, you could be stuck with a bill of at least $30,000 if you go by helicopter.

For fiscal reasons you decide to take the much slower ground ambulance instead. And on the way to the hospital, you die.

This scenario is quite possible under House Bill 35 Worker’s compensation-air ambulances, which would remove Wyoming’s constitutional guarantee to injured workers that all their medical care costs — including first aid and emergency treatment — will be paid by workers’ compensation.

It’s a misguided effort by the Joint Labor, Health and Social Services Committee to save the state money by paying air ambulance firms a fee far lower than they charge for such services.

If it becomes law, the state’s Workers’ Compensation Division would pay twice the amount Medicare would pay for emergency air transportation. It also would allow companies to sue the injured worker for payment if they do not take the state fee.

It seems like a good deal for the air ambulance companies, right? It isn’t. The new legislation would cap the state’s payment at about $12,000, depending on the mileage and severity of the injuries. Air ambulance services routinely levy charges much higher than that. The average emergency medical flight costs between $30,000 and $50,000.

Wyoming lost a lawsuit last year that was filed by four air ambulance companies that objected to the state’s practice of only paying a maximum of $3,900 per flight. House Bill 35 is the Legislature’s initial attempt to fix the legal problem without having to pay the full amount companies charge.

The bill’s supporters believe companies would prefer prompt, reliable payment from the state — even at a lower rate — to the uncertain, costly and time-consuming process of collecting from the worker. “But there’s no way the ambulance companies are going to accept that low amount,” University of Wyoming law professor Michael Duff said in an interview.

Why is he so certain? Because under federal deregulation of air services, they don’t have to. According to a federal study of the issue, companies spend an average of between $6,000 and $13,000 on each call. The flights require a staff of four pilots, four nurses, four paramedics and a mechanic.

But they can charge whatever they want to because the going rate for air ambulance service isn’t competitive. They all generally charge the same amount. And guess what? Federal law prohibits states from regulating air ambulance fees, which is precisely what the state of Wyoming is trying to do.

Under HB35, if a company refuses to accept the state’s maximum offer, it is expressly authorized to send the bill to the injured worker. But since 1915, workers have been protected from such debts after a 1914 amendment to the Wyoming Constitution cleared the way for legislation establishing the workers compensation system.

In exchange for giving up the right to sue their employer, that amendment has guaranteed that a worker injured on the job has all emergency medical bills paid by the workers’ compensation system, Duff noted. It’s part of the quid-pro-quo agreement the state made between itself, employers and employees. It can’t be broken.

But HB35 would unconstitutionally shatter the compromise, Duff contends, and leave an injured worker holding the bag. The worker could not sue his or her employer to recover the total cost of the air ambulance flight, but the bill would allow an ambulance company to legally sue the injured employee to recover its costs.

Now, we don’t know for sure if a company would decide to go after the injured worker because of the legal expenses it would occur. But the whole purpose of the workers compensation system is to make certain that a worker dealing with the pain and suffering — and everything else that recovering from an injury entails — doesn’t have to pay for adequate care.

Workers in Wyoming should not have to fear that an injury at a remote site might bankrupt them because lawmakers decided to ignore the state constitution.

HB35 contains another fundamental flaw. It mandates that the decisions of the state’s workers’ compensation bureaucrats in these cases are final. It leaves no chance to appeal administratively or in court.

“I doubt the Wyoming Supreme Court would agree that denial by the state of rights that were originally obtained through an exchange of fundamental rights under the Constitution was not subject to judicial review,” Duff said.

None of the four air ambulance companies that serve Wyoming testified at the Labor Committee’s meeting when the committee voted in November to introduce the measure in the 2019 session. But there’s absolutely no chance that they will miss any further committee discussion, and you better believe they will have their lawyers in tow.

Luckily there’s a legal backstop to this madness. Duff contends that the entire bill is preempted by the federal Airline Deregulation Act, so it’s a waste of everyone’s time to even consider it. But he’s sympathetic to the plight of the state, which, if no remedy is sought, will have to pay what it considers the exorbitant fees the air ambulance companies can legally charge.

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“What the state needs to do — what all states need to do — is establish a re-insurance pool to cover air ambulance services,” Duff explained. Such a secondary insurance system would spread the risk to all employers in the state who pay workers’ compensation premiums.

If there’s any doubt that HB35 is a terrible bill that should be immediately withdrawn, here’s the topper: Injured workers can submit claims for air ambulance services to their employers’ general health insurance carriers, but those carriers are perfectly free under federal law to amend the plans to exclude coverage of such expenses.

“Perhaps air ambulance companies will respond by simply refusing to transport injured workers. It all sounds very 19th century,” Duff wryly added.

Obviously, back then there were no air services. Not using their helicopters to fly injured workers to hospitals now — in addition to being unethical — would put air ambulance firms out of business. But here in the 21st century, people who are covered by the workers compensation system have the constitutional right to have all bills for such flights covered.

If Wyoming has a problem with that — and the state obviously does, or HB35 wouldn’t exist — legislators can’t be allowed to “fix it” by sticking it to workers.

Kerry Drake

Veteran Wyoming journalist Kerry Drake has covered Wyoming for more than four decades, previously as a reporter and editor for the Wyoming Tribune-Eagle and Casper Star-Tribune. He lives in Cheyenne and...

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  1. When given a choice, people can choose between various types of remedies for their ailments that may be cost based. Cancer treatments, eye treatments, back treatments, and on and on. Transportation choices are also a choice. These choices can be costly if the wrong one is made. Chemo or not? Back surgery or pain killers? Helicopter or ground ambulance? I do think the air ambulance prices are insane though I have also seen helicopter maintenance and flight hour costs to be insane as well. Without stopping price gouging or subsidizing costs some how, they are what they are. Government owned air ambulances that might keep prices down? Negotiated lower costs for greater volume? Just like pharmaceutical costs, no doubt some hefty profits are being made. Perhaps too hefty? Another reason for good healthcare for reasonable prices.

  2. How many times are air ambulances called when ground transport would have been sufficient, or as quick, or quicker? We are being ripped off folks, with the near-unanimous consent of those who govern us.

  3. Discussion of the cost of air ambulance helicopter service certainly adds a whole new dimension to the HIGH cost of any medical services and health care in Wyoming. Several orders of magnitude , actually.

    The article cites widely accepted figures of a single medevac run “retailing” on average for $ 30, 000 to $ 50,000. What I cannot accept is the assertion that each run somehow requires footing the bill for four pilots, four medical doctors or paramedics, four nurses, and a mechanic. Billing a mission at $ a capped price of $ 12,000 if paid with State funds is unacceptable to the air ambulance providers , and Medicare’s top rate of $ 4,000 is beneath the dignity of their considertion. That’s preposterous. But so was not having any representatives from air ambulance providers present to testify or provide input at the Joint Labor, Health and Social Services Committee. The absence of the industry was more than a little conspicuous , and not in a good way.

    Let me offer some baseline comparisons to other helicopter services. When Wyoming Game & Fish contracts for a small helicopter and pilot to hoist a sedated Elk or Deer into the sky and relocate it, they are paying about $ 900/hour for the copter. private sector wildlife technicians and/or animal capture -handlers are additional. Probably adds another $ 500 – 800 and hour.

    What about recreational alpine heli-skiing ? The well known HeliTrax outfit that works Colorado posts their rates on line for taking skiers up to 14,000 feet and dropping them off, and picking them up. It costs each skier $ 1345 for the day . Four skiers flown to a private backcountry cabin base and skiing all day get charged a flat rate of $ 5200 inclusive , including amenities.

    Just two off-the-cuff examples of the going rates for commercial mountain helicopter services presented for purposes of discourse. The gulf between the heli-skiing service and the medevac service is immense. Reasoning says the difference has to be on the medical side of the equation ‘cuz it sure ain’t the cost of the helicopter , pilot, and mechanic. Not until you get up into the realm of the Skycrane and Chinook heavy lifters anyway. The Augusta-Westland AW 139 is a 2 crew-8 passenger copter widely used in civil aviation and emergency services has an operating cost over life of approximately $ 2200 / hour. A copter that size is overkill for a typical backcountry evac of a single patient , which can be done more often with the ubiquitous Bell Jet Ranger 407, which books at $ 600 / hour for jobwork. It seats a crew of two and has a cabin space for 5 passengers and baggage.

    The Bottom Line is private or commercial air ambulance providers will have a hard time dissuading the notion that they are not Robber Barons in the sky , taking advantage of the disadvantaged in their time of dire need. Make your own case.

    Kerry is correct in his assertion that HB35 is a very bad bill. Legislators are sorely in need of some broader education . Good faith bargaining by the air ambulance providers – transparently – would be helpful .