With an expansive territory of more than 10,000 square miles, Harney County is larger than some states. However, less than 8,000 people call the county home. With room to roam, the benefits of the frontier lifestyle are plentiful. However, the vast landscape can be challenging for emergency medical care providers who are tasked with the responsibility of serving a small amount of people in a large amount of space.

Some residents live more than 100 miles away from Harney District Hospital (HDH), which is the only hospital in Harney County. Although the Critical Access Facility is completely capable of providing a wide range of medical services, some emergencies require patients to be transported to larger facilities, such as those in Bend, Portland, Ontario, and Boise, Idaho.

Fortunately, both ground and air emergency ambulance services are available in Harney County to connect patients with the care they need. Air ambulance services are primarily provided by AirLink Critical Care Transport and Life Flight Network. Ground ambulance services are provided by HDH Emergency Medical Services (EMS), with memberships offered through FireMed. The availability of multiple emergency transportation providers is an obvious asset to the community, but the range of options can pose problems for consumers who are trying to decide among membership programs.

Even with medical insurance, emergency transportation costs can leave patients with significant out-of-pocket expenses. Thus, membership programs are used to pick up where insurance coverage falls short.

HDH EMS Manager Jeff Sceirine explained that medical insurance typically covers about 80 percent of transportation costs, leaving patients with the remaining 20 percent. However, because the total cost of transportation services is steep, the remaining patient responsibility can be significant.

“Let’s say it’s $30,000. You’re going to have a 20 percent deductible on your insurance, so you’re going to be responsible for $6,000 if you have health insurance,” Sceirine said. “Who needs a $6,000 bill when you’ve also got all the hospital bills coming in and all the other catastrophe?”

Costs can be astronomical for patients who lack health insurance and memberships to ground and/or air ambulance programs. For example, Sceirine said one of his friends received a $42,500 bill after being flown from Drewsey to Boise.

Unfortunately, when the situation is dire, emergency responders don’t have time to take patients’ memberships into consideration. Their number one priority is getting patients the life-saving care they need.

“If it’s life or death, I don’t want to worry about how much you’re going to have to pay to keep you alive,” Sceirine said. “It would be wrong for us to say, ‘Well, we’re going to wait for another 30 minutes for this helicopter to come because you’ve got membership,’ as opposed to calling the closest one. I’m just here to move you from point A to point B and get you to the people you need to see. The unfortunate part is that it’s a business, and so someone is going to bill you.”

In order for Harney Countians to have complete membership coverage, they would have to purchase three separate memberships — one for AirLink, one for Life Flight, and one for FireMed.

For ground ambulance services, FireMed membership can be purchased separately or in combination with an AirLink membership for an extra $50 a year. FireMed memberships are honored by more than 80 agencies throughout Oregon.

In the past, AirLink and Life Flight had a reciprocal agreement, meaning that membership to one air ambulance service would be honored by the other. Unfortunately, however, reciprocity was lost on June 1, 2012, when AirLink was purchased by Med-Trans Air Medical Transport, which is a private, for-profit company.

“Before that, AirLink was a nonprofit. So when you applied for membership to AirLink, through reciprocity, you got membership with Life Flight,” Sceirine explained. “All the nonprofits have an agreement with each other to provide this reciprocity across programs. When AirLink was bought out in 2012 by Med-Trans, Med-Trans said that they couldn’t honor Life Flight’s membership, and Life Flight said they couldn’t honor AirLink’s or Med-Trans’ membership program.”

Kristin Lingman, business development and marketing manager for AirLink, explained that Medicare law prevents AirLink from offering reciprocity with Life Flight. However, she added that lobbyists are currently advocating for changing that law.

“We want to do what’s best for the community,” she said. “The bottom line is, none of us want to see people go without. None of us want to see someone get saddled with a big expense.”

A one-year AirLink membership is $65 for an entire household, and households are defined liberally.

“It doesn’t have to follow the mom, dad, kid structure. We understand that modern residences don’t always follow that way of being,” Lingman said, adding that a household could consist of a group of roommates.

AirLink is part of the AirMedCare Network, which is an alliance among Med-Trans, REACH Air Medical Services, and Air Evac Lifeteam. Thus, AirLink membership is honored by more than 260 helicopter and airplane air ambulance bases located across 32 states.

However, if a provider within the AirMedCare Network is not requested for a patient transport, or is unavailable for any reason (such as being committed on another patient flight or out of service due to weather or maintenance-related issues), AirLink members will be responsible for payments due to other service providers.

Sceirine said ambulance services are dispatched based on availability and proximity to patients, which is why he, Lingman, and Jacob Dalstra, a regional director for Life Flight, recommend purchasing multiple memberships.

“Life Flight recommends getting both air ambulance programs and the FireMed, as well. If you are having a heart attack or stroke, the last thing I want to worry about is finance,” Dalstra said, explaining that patient care is his priority.

Life Flight is a nationally-recognized, not-for-profit air medical service with bases in Oregon, Idaho, Montana, and Washington. Members are covered by all Life Flight bases and by reciprocal agreements with other regional air medical transport organizations in Idaho, Washington, Western and Central Montana, Northern Nevada, Northern California, and Southeast Alaska.

Membership is $65 per family per year. Benefits cover an individual, his/her spouse or domestic partner, and dependents claimed on his/her income tax return. Elderly or disabled family members living in the same household are also covered.

The combined cost of all three memberships is $180 annually. Although that’s only a fraction of an emergency transportation deductible, it’s still a chunk of change.

If a consumer can only afford one membership, Sceirine said he recommends ground ambulance coverage.

“You’re more likely to use ground ambulance than you are an air ambulance,” he said, explaining that only about 35 people are flown out of Harney County every year, while ground ambulance calls average around 900 annually.

Included in those numbers are transfers from HDH to other facilities.

“Our doctors are very discretionary about when they’re going to fly someone,” Sceirine said, adding that flights are usually reserved for patients who can’t be out of the hospital very long.

Sceirine said doctors typically send patients by ground ambulance when they need to get to the next hospital quickly and out-of-hospital time isn’t as much of a concern. That’s because, when sending patients by ground, doctors don’t have to wait for air ambulance services to arrive. Sceirine said flight times for helicopters coming from Bend or Ontario are around 40 minutes, but it often takes them 15 to 20 minutes just to lift off. He explained that pilots are required to follow stringent procedures, such as checking the weather and having certain clearances, before they’re allowed to leave.

There may be another option for consumers who don’t want to risk going without air ambulance coverage, but struggle to afford the cost of multiple memberships.

Offered through Bancorp Insurance, MASA Medical Transport Solutions will pay any balance billing from any medically-necessary emergency transportation, ground or air, anywhere in the United States, regardless of provider.

“MASA covers the cost, after insurance, for any ground or air ambulance in the country,” Bancorp Insurance agent Cheri Martinen explained.

“Quick, accurate claim processing is the key to MASA’s high client satisfaction ratings,” she said, adding that there is no cap on the payment of claims.

MASA coverage can be employer paid or offered as a payroll deduction for as low as $99 per year per household, regardless of relationship.

“It’s not just your dependents. It can be anyone who lives in the home with you,” Martinen explained.

She added that single-enrollment options are available, but coverage is more affordable if it’s offered through an employer. However, she noted that sole proprietors (such as plumbers, contractors, and ranchers) can qualify for employer-based coverage through their own businesses.

Martinen said MASA customers don’t need emergency transportation memberships, but MASA supports Life Flight and AirLink by making payments to them.

“It’s a win-win-win,” she said. “Life Flight and AirLink still get paid.”

However, Dalstra and Lingman asserted that Life Flight and AirLink memberships ensure the programs’ viability into the future.

“Life Flight is a nonprofit, so membership keeps the operation going. I would encourage people to support their local operations,” Dalstra said.

“By buying either one of our memberships, you are ensuring that our programs can continue to exist in rural communities,” Lingman said, adding that AirLink has been successful because of community support.

She also noted that AirLink supports communities by assisting with search and rescue efforts as well as EMS education and training.

For additional information regarding AirLink, visit www.MyAirLink.org. For more information about Life Flight, go to www.lifeflight.org. Additional information concerning MASA can be found online at www.masamts.com.