Fatal wreck near Logan

In this file photo, first responders load a patient into a REACH Air Medical Services air ambulance after a two-car collision on frontage road east of Logan on March 7, 2017.

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When a 6-year-old Gallatin County boy arrived at Bozeman Health nearly three years ago with a brain tumor, he needed an emergency flight to Denver for care. With more than $40,000 left on the bill for that flight, a fight over how much the trip should cost and who pays is still unfolding.

Stan and Rainy Wagner got a $109,590 bill from REACH Air Medical Service for their son’s emergency flight. That was later dropped to $62,990 after REACH said it corrected a billing error. The Wagners claim REACH didn’t tell them how much the trip would cost beforehand and that they were overcharged.

REACH countered its prices are fair and it’s still waiting for a big portion of the bill to be paid. The California-based company brought Blue Cross Blue Shield of Montana into the case by saying the Wagners’ insurers should have covered the tab.

In April, U.S District Judge Brian Morris denied Blue Cross’ request to dismiss REACH’s counter suit, saying more facts need to be told.

That’s left all three groups to build their arguments, with the Wagners’ attorneys hoping the case gets certified as a class-action lawsuit to let them seek damages for other air ambulance clients.

The case echoes a story Montanans have told before: Families who need the life-saving rides land in debt for tens of thousands of dollars. Last year, state lawmakers passed a series of bills trying to protect Montanans from out-of-pocket charges when their insurance doesn’t fully cover an air ambulance flight.

But the Wagners’ story began before that. The couple took their 6-year-old son to his pediatrician in August 2015. A CT scan revealed the boy had a life-threatening brain tumor, according to the initial legal filing.

The Wagners said they agreed to have REACH transfer their son to the Children’s Hospital in Denver after their doctor said an air ambulance was the best option. However, they say the contract they agreed to didn’t specify the cost for the one-way, 535-mile flight.

After they got their bill, Blue Cross Blue Shield of Montana paid $22,933. That left the remaining $40,057 to the Wagners.

The Wagners attorney wrote REACH’s bill “exceeds reasonable amounts” and said the charges don’t “represent the reasonable worth of the services rendered.”

The Wagners and their attorneys argue REACH should re-examine the bills it’s sent customers, reducing them to a fair value. They also say the company should be required to specify its billing rates in its contracts up front.

REACH answered in November of last year that they had an implied contract with the couple, not a written one. Their attorneys wrote that even if the company had time to walk through their prices with the Wagners, there are “too many unknown factors” to outline what patients’ out-of-pocket costs would be.

They continued that running an air ambulance is expensive, adding REACH’s average charge in Montana around 2015 was roughly $57,000.

REACH countered that despite the fact it’s been years since the flight, “the Wagners have paid nothing for the transport and BCBS Montana has paid just 36 percent.”

REACH said since payments from uninsured patients or people covered by a government health program don’t cover the cost of their services, commercial health plans like Blue Cross should foot the bill.

“Without payors who reimburse REACH the full amount for its services, REACH will be forced to close bases, and this will leave residents of Montana without needed air ambulance transportation in many instances,” REACH’s attorney wrote.

As of April 18, there were 14 air ambulance providers operating in Montana. Blue Cross Blue Shield Montana had contracts with seven of those providers — meaning the insurer and providers agreed on a contracted rate — but that didn’t include an agreement with REACH.

In February, Blue Cross responded they reimbursed Reach according to the Wagners’ health plan contract. The company’s lawyers wrote the case is a routine payment dispute between a patient and a provider and claimed REACH’s counter lawsuit was “an effort to access deeper pockets.”

The defendants have until Feb. 18, 2019, to file a reply with the court before a hearing to certify the lawsuit is scheduled.

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Katheryn Houghton can be reached at khoughton@dailychronicle.com or at 406-582-2628. Follow her on Twitter @K_Hought.

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