Michigan Firefighter's Insurance Company Authorizes -- Then Denies -- Emergency Medical Flight Coverage
While vacationing with his family in Puerto Rico this April, Peter Counseller, a full-time Lieutenant firefighter with the East Lansing Fire Department, developed an acute gastrointestinal hemorrhage, rapidly losing more than 70 percent of his blood volume. Emergency department medical staff in Humacao, Puerto Rico assessed a multitude of serious symptoms: lower GI hemorrhage, critically depleted red blood cells, loss of consciousness, rapid heart rate, abnormally low blood pressure, and low oxygen saturation levels.
Counseller was admitted into the hospital's three-bed intensive care unit, where despite his critical condition and dangerous blood loss, he was hospitalized for nearly six hours before receiving blood. When Counseller's wife inquired about the blood's source and whether it was tested for diseases, the hospital did not have an answer.
Counseller's wife, an experienced trauma nurse, described the startling conditions at the facility. Patients shared bed pans and urinals. The hospital had no sheets or blankets available to warm Counseller, who was in hemorrhagic shock from the copious blood loss. He was covered with plastic until his wife provided sheets and blankets. In spite of being hospitalized for hours, this critical patient had not even undergone routine diagnostic testing and Counseller's wife became extremely concerned about her husband's health and the consequences of remaining in a hospital where he was not receiving adequate medical treatment.
Mrs. Counseller contacted international air medical transport provider Angel MedFlight Worldwide Air Ambulance Services, who intervened on behalf of the seriously ill firefighter. Angel MedFlight professionals contacted Counseller's primary care physician, who advised that "the medical facts and the clinical situation require proceeding to a more advanced medical care setting." On April 2, 2011, Angel MedFlight performed an emergency air medical transport to the closest, most appropriate medical facility, The University of Miami Hospital in Miami, Fla.
"We are pleased to report that Peter did obtain the immediate medical attention he needed," states Jeremy Freer, President and CEO of Angel MedFlight. "He was able to return to his duties as a firefighter earlier this week. We are shocked, however, by the treatment this hero has received from his insurance carrier. They authorized the medical flight, then changed their minds, claiming that he had left the facility 'against medical advice.' That is no way to treat an insured, especially one who puts his life on the line every day to save the lives of others."
An April 11, 2011, communication from Physician's Health Plan of Mid-Michigan (PHPMM) advised Counseller that the medical flight would be covered under his insurance policy and negotiated a discount with the provider. A May 12, 2011, letter from PHPMM, however, reversed the decision, refusing approval for air medical transport based on his decision to voluntarily leave the facility in Puerto Rico.
"Yes, Peter did leave the Puerto Rico facility voluntarily -- with the agreement of his primary care physician. As defined by the summary plan description contained in Peter's insurance policy, the 'Primary Care Physician can order the transports,'" says Freer. "Peter's primary care physician felt strongly that if he did not transfer to a more advanced hospital, his life was in jeopardy. He had no other choice."
With the help of Angel MedFlight's legal team, Counseller is appealing the insurance coverage denial. Adds Freer, "All we are asking is that Physician's Health Plan of Mid-Michigan do the right thing for its insured. As a firefighter who has dedicated his career to saving lives, he deserves that."
The physician who treated Counseller in Miami recently e-mailed him, telling him he was lucky to be alive.
About Angel MedFlight Worldwide Air Ambulance Services
Angel MedFlight, founded in 2006 by Jeremy Freer, is based in Scottsdale, Ariz. The company coordinates domestic and international air medical transportation, commercial medical escorts, ground ambulance services and provides discretionary insurance benefit assistance. Angel MedFlight's One Touch Promise™ assures that every detail is handled and all resources are committed to guiding the process from start to finish with a compassionate team of experts in the fields of medicine, aviation, insurance law and case management. Learn more at www.angelmedflight.com.
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