Kaiser Permanente denied 20 air ambulance flights from the San Juan Islands in two months, according to the county board of health.

During its regular meeting on Jan. 16, the board of health discussed the need to intercept in the refusal of life-saving air ambulance flight claims.

“I sent a relatively terse email to staff about this. It is unacceptable,” said Rick Hughes, county council member for Orcas and board of health member. “This board needs to take immediate action to pass an ordinance. We need to contact the state, and this has to stop.”

Hughes said a recent meeting with a resident brought the topic to his attention. He said the patient had a heart condition and an AirLift Northwest subscription but was rejected coverage by Kaiser. With a membership, AirLift Northwest will only bill the patient’s insurance, however, if the insurance does not pay the claim the responsibility for payment returns to the patient.

“If you break your collarbone on Orcas Island after 5 o’clock it is not, in my opinion, fair to make someone wait for the ferry 10 hours later,” Hughes said as an anecdote. “We cannot hamper medical attention or medical service because of money. Period.”

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

There are two emergency air evacuation providers in the islands, AirLift Northwest and Island Air Ambulance. Both have supplemental annual insurances you can 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 University of Washington service that uses a helicopter based in Bellingham to transport island patients. The service operates in Washington and Alaska. Island Air Ambulance is a fixed-wing airplane that can fly in more severe weather conditions than a helicopter can and is locally owned and operated.

Anne Presson, the superintendent for both Lopez and Orcas islands’ public hospital districts, said she has been in discussions with AirLift Northwest, Island Air, UW Medicine and the vice president of contracting for Kaiser Permanente.

“He was very understanding of our unique situation,” Presson said. “They haven’t specifically recognized that we are very unique.”

According to Presson, the policy is a “blanket” covering all Kaiser Permanente patients.

The board entrusted Hughes with drafting a letter to Kaiser Permanente outlining the problem with denying air ambulance services in a community isolated by water. San Juan County Health and Community Services Director Mark Tompkins said the county needs to go above the insurance agency’s head on this one.

“I would also suggest sending it to the insurance commissioner of the state and to others at the state level. If there’s an RCW that can be changed to alleviate this issue I think it’s more important that we don’t just send it to Kaiser,” he said. “Kaiser has made their decision, they have made their policy. We can certainly appeal to them, but if you want effective change, I think sending it to other folks would be appropriate.”

County council member for San Juan Island and board of health member Bill Watson was taken aback by the denials as he has Kaiser Permanente and was not aware that airlift would be denied.

“This is not a San Juan County issue, in my opinion, this is an insurance company making unilateral decisions about what are appropriate and inappropriate medical procedures that are going to be followed especially under emergency situations and I find that unacceptable that a single company can make those determinations,” he said.

Watson added that the county has an obligation to inform the residents of San Juan County of the Kaiser Permanente issue before they receive a bill for thousands of dollars for a service they thought was covered by the insurance company. Tompkins emphasized the need for the community to be aware of what services their insurance company does and does not cover regardless of what company they’re insured by.

Hughes drafted a letter to Kaiser Permanente on Jan. 28 and sent to board members for review.

“Someone will die or could die if we do not take action,” Hughes said. “I can’t live with that.”