Madden Surbaugh sat with his wife at their Orcas Island home on New Year’s Day debating whether he should call someone about the pain in his chest, jaw and left arm. He knew the clinics were closed for the holiday and wondered if it was really an emergency or if he was just overreacting.

“We have airlift insurance. What’s the worst that happens? Let’s go and check on this,” he said. “One of the major decisions on that was that we had our airlift insurance.”

Surbaugh called emergency medical services, which, after spending 40 minutes getting pre-authorization for the flight from his insurance, had him aboard an AirLift Northwest helicopter en route to a hospital in Bellingham.

Luckily for Surbaugh, his chest pain turned out to not be a heart attack. But because of that luck, Kaiser Permanente — his health insurance provider — deemed the air ambulance ride as being medically unnecessary. Medical air transport from the islands can cost more than $20,000. If insurance refuses to pay, the patient is sent the bill and is responsible for appealing the denial with their insurance provider.

“We all know there’s a problem here. I just wanted to let you know, as someone who lives here, that’s my experience,” he said to the San Juan County Board of Health during a meeting on Feb. 20. “And [Kaiser is] still trying to deny the claim at this point in time, even though they pre-approved [the flight]. … We’re still fighting that, knowing that if Kaiser doesn’t approve it, then AirLift doesn’t approve our airlift insurance that we do have, leaving us with a massive bill.”

More than a dozen concerned citizens gathered tightly into the San Juan County Council chambers for the board of health meeting to hear the status of the ongoing discussions between Kaiser and local health representatives.

“If we’re going to continue on this, we need to have a united front,” San Juan County Board of Health member and County Councilmember Jamie Stephens said.

There are two emergency air evacuation providers in the islands: AirLift Northwest and Island Air Ambulance. Kaiser began denying emergency flights from patients in the San Juan Islands in September 2018, explained Rick Frazer, presenting on behalf of Island Air. He said the company currently has 20 outstanding denial claims from Kaiser.

Kaiser Permanente is the only insurance available to San Juan County residents except for through an employer or Medicaid, and it requires preauthorization for air medical transportation. In an emergency situation, however, the board of health agreed there is not enough time for preauthorization.

“It’s not an easy process,” AirLift Northwest Executive Director Chris Martin said, adding that her company hasn’t had the same number of denials from Kaiser as Island Air Ambulance has had. “We will continue to be advocates the whole way through.”

Both AirLift Northwest and Island Air Ambulance have supplemental annual memberships you may purchase to ensure you’re not charged for the “patient’s responsibility” portion of the bill. It is encouraged that residents have a subscription to both as availability and weather can have an impact on which option is chosen.

AirLift Northwest is a UW Medicine service that uses a helicopter based in Bellingham to transport patients. It also has a fixed-wing airplane that flies out of Boeing Field in Seattle, and the company services Washington and Alaska. Island Air Ambulance is a fixed-wing airplane and is locally owned and operated.

Dr. Michael Sullivan, medical director for the San Juan Islands’ Emergency Medical Services, said he has had several letter correspondences with Kaiser but the company isn’t answering his questions to his satisfaction and has not taken him up on his offer of a face-to-face discussion.

“This is a really troubling issue,” Sullivan said. “I want to move this down the road. … [Continued denials] could lead to potential morbidity or even mortality.”

Sullivan said that a patient may refuse an air ambulance flight for fear of receiving a bill if their insurance denies the claim. He explained that EMS looks at the financial implications to a patient but that the patient’s health comes first.

“They’ve done all the right things,” Sullivan said about a hypothetical patient who has purchased memberships with the local air ambulances and has insurance coverage. “I want [Kaiser] to be held accountable. I want to hear from them.”

Lopez and Orcas hospital district superintendent Anne Presson previously worked for Kaiser for 20 years. She said Kaiser representatives indicated to her that they want to support the community.

“Getting in a room with them is the best thing,” Presson explained. “We’re really jeopardized.”

San Juan County Health and Community Services Director Mark Tompkins said he was informed on Feb. 19 that Kaiser management was not interested in coming to the islands to discuss the problem with stakeholders. According to Tompkins, it believes it is best for the situation to be solved in a “physician-to-physician discussion” with Sullivan.

“I’m not seeing any significant movement in that direction,” Sullivan said. “I am hopeful that I will have a dialogue with Kaiser.”