Hawaii is no place to go for a heart or lung transplant. Those procedures haven’t been offered in the islands since Hawaii Medical Center closed in 2012.

Some prospective organ transplant recipients who live in Hawaii have enough time to travel to mainland hospitals on a commercial aircraft, but others require emergency transportation by air ambulance. That can cost from $80,000 to $130,000.

Air ambulance companies require payment upfront, and don’t usually offer loans or payment plans. Medicaid covers transport, but private insurance companies don’t always pick up the tab.

Some legislators hope to ensure emergency mainland transport is covered with House Bill 687, which passed its first hearing last week in the House Health and Human Services Committee.

Queens Hospital Emergency sign. 14 feb 2017
When a medical emergency requires a flight to the mainland, the costs can be staggering. Cory Lum/Civil Beat

“We have seen families liquidate their retirement accounts, sell every available asset, and all but guarantee their future financial bankruptcy in order to pay for this transportation,” wrote Oren Bernstein, an anesthesiologist, in testimony.

When Rodney Tam, the late deputy attorney general, needed a lung transplant, he was too sick to fly, testified his wife, Tammy, at a Wednesday hearing. The air ambulance provider had already collected $65,000. He was also unable to fly to the mainland on his second try, but the Tams paid another $85,000.

“By the time the transport could be arranged, it was too late for him,” she said.

His organs began failing and he died in California last year.

HB 687 would require insurance companies to cover transportation costs for patients who have a “potentially reversible disease,” or are in need of a heart or lung transplant, artificial heart or heart pump.

Eligible patients without any life-saving treatment options available in Hawaii must also have a medical team ready to treat them on the mainland, according to the bill.

The current draft of the bill requires insurance companies to pay for patient transport, but the Hawaii Attorney General’s Office noted in written testimony that it’s possible the state could end up on the financial hook for those costs because of wording in the federal Affordable Care Act about requiring new benefits.

“Some folks with private insurance, it’s just a battle with the insurance to help get coverage.” — Dr. Brian Wu

The Hawaii Medical Service Association, the state’s largest private health insurer, commented on the bill but did not take a position. Kaiser Permanente Hawaii testified that it supported the intent of the bill.

Dr. Brian Wu, a pediatric pulmonologist in Honolulu, told Civil Beat that many of his patients needing mainland transport have been covered through Medicaid. Private insurance companies will sometimes change the language of the patient’s policy upon appeal to provide such coverage, he said.

“Some folks with private insurance, it’s just a battle with the insurance to help get coverage,” Wu said.

HB 687 originally called for establishing in state law the current federal requirements that people can remain on their parents’ insurance plan until they turn 26 and that insurance companies can’t deny benefits based on pre-existing health conditions. That language was gutted and the bill was amended to include the current language on emergency transport by Rep. Linda Ichiyama, vice chair of the House Consumer Protection and Commerce Committee.

The transplant issue affects seven to 10 adult patients in Hawaii per year, Ichiyama said, presenting a challenge that mainland patients wouldn’t have to face. Insurance companies have been cooperative in working on the bill’s language, Ichiyama said.

Changing an insurance policy to add transport coverage “often creates delays for families who are waiting to find out whether they can get covered,” Ichiyama said. “More delays can sometimes mean complications.”

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