Insurance company denies coverage for $65,000 transport citing no pre-approval

WASHINGTON — When Amanda Boley suffered cardiac arrest, she needed life-saving emergency transport to the nearest trauma center. Six weeks later, while still recovering, she received a $65,000 bill after her insurance company denied coverage.

The reason? The insurance company claimed she needed “pre-authorization” for the flight — while she was unconscious and fighting for her life.

“I was dead and then I was unconscious,” Boley said.

Boley suffered cardiac arrest last October. Emergency responders determined she needed care at a Level One trauma center, but the closest facility was 44 miles away.

With no time to spare, paramedics airlifted Boley by helicopter. She regained consciousness two days later.

“I woke up, I had IVs everywhere out my neck, my arms, I was intubated, my arms were restrained to the bed,” Boley said. “And I remember looking and I knew immediately this is a hospital.” 

Six weeks later, still recovering from her ordeal, Boley received a $65,000 bill for her emergency helicopter transport. Her insurance company, Anthem, denied coverage stating Boley needed “pre-authorization” for the flight.

“That night I was dead and then I was unconscious,” Boley said. “I don’t know how I’m supposed to get pre-approval.”

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Patricia Kelmar, Senior Director of Health Care Campaigns for the Public Interest Research Group (PIRG), says Boley’s case isn’t isolated, although data is limited because insurance companies aren’t required to disclose information on coverage denials.

“I can’t imagine what the pre-approval would be in an emergency situation,” Kelmar said. “It doesn’t even make sense.”

Kelmar believes artificial intelligence may be increasingly responsible for these types of denials.

“We know right now that insurance companies are using AI to deny claims,” Kelmar said. “Now of course we all want to use AI when it’s more efficient and it saves money, but at some point these are individuals who have medical records, medical histories that may not fit into an AI model and so it’s important that there’s a real human being that’s looking at this information.”

Boley appealed her denial twice. Both times Anthem doubled down, stating “air ambulance services are subject to medical necessity reviews” and “will only be covered when approved in advance.”

“I cried, I felt sick. Because how am I gonna pay that?” Boley recalled.

After WUSA9’s sister station in Indianapolis fought the $65,000 bill on Boley’s behalf, Anthem suddenly reversed course, admitting they made a mistake and covering the bill in full.

Boley says she is relieved but not reassured it won’t happen to someone else.

“When people have a medical crisis happen they should be allowed to heal. They should not have to worry about struggling to make ends meet so that the insurance company can profit,” she said.

According to PIRG, when patients fight back, they usually win. As many as 75% of appeals result in overturned denials. However, many consumers don’t know how to navigate the system.

If you’re facing an insurance denial, experts recommend:

1. Request itemized medical bills
2. Contact your HR department — employers paying for insurance often have more leverage than individual patients
3. Report unfair medical billing decisions to state and local regulators

“You may be one voice, but if you join with other voices of people who’ve been denied, that can make a difference,” Kelmar said.

If you’ve experienced unfair insurance denials, contact Eric Flack via email, [email protected]. The Public Interest Research Group also offers guidance through their website at PIRG.org, where you can report your own insurance denial cases.

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