Ledyard — In April, it took a helicopter 20 minutes to fly Gideon Johnson from Backus Hospital in Norwich to Yale New Haven Children’s Hospital, where the 3-year-old, who has a rare genetic disorder, was treated for pneumonia and low oxygen. 

With their son being taken by helicopter, Jordan Johnson and Yuxin “Hannah” Shi said they made the trip by car in about 50 minutes.

“We were worried about the cost right from the start,” Jordan said of the helicopter transport, which he said neither he nor his wife signed off on in advance.

“I probably would have been hesitant to do so,” he said, recalling that he arrived at the Backus emergency room after doctors had decided his son Gideon's mode of transportation to New Haven. “To me, it was not 100% necessary. An ambulance may have been completely fine.” 

Seven months later, the Ledyard couple’s anxiety has not subsided, with $28,222.97 of a $53,091 bill submitted by Med-Trans Corp., which provided the helicopter, still outstanding. Jordan's insurance carrier at the time, United Healthcare, paid $24,868.03 for the out-of-network service. 

Yuxin said the helicopter crew included a pilot, a nurse and a third person, and Gideon was hooked up to oxygen and an IV line during the flight.

"We're not trying to blame the doctor who made the decision," Yuxin said. "We're just confused, shocked by how big the bill was. It should be more reasonable."

Jordan said he and his wife have been stressed over the possibility that they may be on the hook for the unpaid portion of the bill, or at least a sizable portion of it. 

For them, it’s little or no comfort the so-called No Surprises Act, set to take effect Jan. 1, promises to prevent consumers from receiving surprise medical bills for emergency services provided by out-of-network providers at in-network facilities. Under the federal law, consumers only will be liable for regular in-network, cost-sharing amounts. 

Med-Trans, based in Denton, Texas, and United Healthcare entered into an in-network agreement that took effect Aug. 1, 2021 — also too late to have any bearing on the claim involving Gideon Johnson. 

“Our Patient Advocates are currently working with the patient’s insurer to resolve the outstanding balance,” a Med-Trans spokesman said in a statement. “We like to work directly with our patients so we can find a good solution for them. Our goal is to help them advocate with their insurance company to get the insurer to cover the service that a physician or emergency responder felt was critical for that patient." 

Jordan Johnson, however, said he has been reluctant to engage with Med-Trans since a Nov. 1 phone conversation in which he felt a Med-Trans representative tried to pressure him for refusing to sign a consent form authorizing Med-Trans to pursue the unpaid portion of the helicopter bill. 

About a month earlier, Jordan said, he’d been “blindsided” by a letter that accompanied the consent form.

“We would like to send an appeal to your insurance carrier to have the claim reviewed for corrective payment,” a Med-Trans representative had written.

In the phone conversation, Jordan said he told the Med-Trans representative he wasn’t comfortable signing the consent form, which he said would have given Med-Trans access to his son’s private medical information. Jordan said lawyers he consulted had advised him against signing the form.

"OK, do you want us to speak to the lawyer? No? Then we can bill you directly," Jordan said the Med-Trans representative responded. 

The exchange left him feeling far differently than he had months earlier when he received a “Claims Summary” from United Healthcare, Jordan said. That statement indicated the $28,000 balance had been covered by a discount the insurance carrier had negotiated with the provider (Med-Trans). 

“The total amount you owe the provider(s) is $0.00,” the summary says.

“At that point, I did think we were OK,” Jordan said. 

Unfortunately, such language in an insurance company’s statement, or explanation of benefits, can be misleading, according to Sean King, staff attorney for the state Office of the Healthcare Advocate, whose help Jordan and Yuxin sought. 

“The language says United Healthcare came up with what it considered a reasonable amount (for the helicopter transport) and it was transmitted to the transport company as an offer, but the company may not have fully accepted it,” King said. “They may not have come to an actual agreement.” 

He said it does appear Med-Trans is making a good-faith effort to get back to the negotiating table. 

“It’s still early as far as our involvement in this case, but it could evolve in a very positive way for the family, which should be focused on taking care of their child and not dealing with insurance disputes,” King said.

Resolving such cases can take months, even years, and can involve litigation, which Jordan and Yuxin said they hope to avoid.

Jordan, a software developer, said his son's condition — known as Edwards’ syndrome, or trisomy 18, which causes severe developmental delays due to an extra chromosome — already has led to several million dollars in medical bills during Gideon’s young life. Thanks to health coverage through Jordan’s employers, the family’s share of the expenses has been manageable. Paying high annual premiums and “probably a few thousand a year beyond that” out of pocket, the family has held its own, Jordan said. 

Jordan and Yuxin are concerned, though, that the future could hold more out-of-network emergency expenses like the helicopter ride.

King said families whose insurance plans involve high premiums and high deductibles shouldn't be stuck with additional out-of-network charges that come as a surprise.

"People shouldn't have to bear those additional expenses," he said. "That's why the No Surprises Act is so important."

b.hallenbeck@theday.com