PORTLAND, Ore. — Gracelyn Guyette had taken a fall. The 5-year-old looked cold and pale. She couldn't move her arm.
"What concerned me most as a mother is your child is just kind of listless and her eyes seemed kind of distant," said Gracelyn's mom, Chrystal.
After examining an X-ray of her arm, doctors at an urgent care clinic sent Gracelyn to the nearest emergency room, Asante Rogue Regional Medical Center in Medford.
Hospital records listed Gracelyn's admission type as "Emergent Severe or Life Threatening." Doctors explained she'd suffered a broken elbow at the growth plate and required emergency surgery. She needed to be airlifted immediately, the hospital explained, because no pediatric orthopedic surgeon was available locally to perform the procedure.
Hospital staff made arrangements for an air ambulance to transport Gracelyn from Medford to Portland, a roughly 50-minute flight avoiding icy roads and any possible delay.
"It would feel odd as a parent, when all these doctors are telling you she's got to go by air ambulance, now to say, 'Nope, wait,'" Chrystal Guyette said.
On Feb. 25, 2022, medics loaded Gracelyn into a small plane. The air ambulance, operated by Mercy Flights, flew Gracelyn and her mother to Portland, where she underwent emergency surgery at OHSU Doernbecher Children's Hospital. The procedure was effective, and soon, Gracelyn returned home to southern Oregon.
Then, the bill came. The insurance company, Anthem Blue Cross Blue Shield, expected Gracelyn's family to pay the full air ambulance bill, nearly $60,000.
"It's mind boggling and infuriating that this can occur," said Chrystal Guyette.
The insurer was willing to pay for the ambulance on the ground — to and from the airport — but not the airplane. According to its denial letter, Anthem Blue Cross Blue Shield determined that Gracelyn's air ambulance ride was not medically necessary.
"There's nothing that I can possibly think of that we would have done differently in this situation," said Gracelyn's father, Brian Guyette.
The family appealed, as did the air ambulance provider Mercy Flights. But at every turn, Anthem Blue Cross Blue Shield denied their claim.
And Gracelyn's family isn’t alone.
Denver television station KUSA has reported on other families facing hefty air ambulance bills after their insurance claims were denied.
Earlier this year, the National Association of EMS Physicians wrote to federal health officials saying they've seen a "spike in denials of claims" — often involving air ambulance bills. The doctors said the No Surprises Act, the federal law intended to protect patients from unexpected medical bills, was partly to blame.
Insurers can get around the law if they determine care is "not medically necessary," and insurers themselves get to decide what that means.
"There is a major problem going on that is affecting more and more families," said Brian Guyette.
KGW emailed Anthem Blue Cross Blue Shield in late November and provided a patient privacy waiver from Gracelyn's parents.
Nine days later, an Anthem Blue Cross Blue Shield spokesperson responded by email. The claim was approved.
"We rely on health care providers to provide accurate and complete information when submitting claims. In this case, we did not originally receive the necessary medical information to justify air transport, which resulted in the claim being correctly denied," wrote spokesperson Janey Kiryluik. "After receiving more information about this member's medical condition through the health plan's second-level appeal process, the claim was approved."
The spokesperson declined to explain which health care provider failed to provide the necessary medical information. Both the hospital, Asante Rogue Regional Medical Center, and the air ambulance company, Mercy Flights, declined to comment for this story.
Gracelyn's parents are relieved the claim was approved but don't understand why it took so long.
"The appeal they just approved was identical to what was sent before," said Brian Guyette. "Maybe a new set of eyes that looked at it, but I think certainly the pressure of having media on them is really what made this get approved."
Do you have a story about insurance companies declining to cover costly air-ambulance rides? If so, we’d like to hear from you. Please fill out this form.