The cost of an emergency medical flight out of town may be going up.

Beginning May 2013, insurance provider Apollo Medi Trans will not cover 100 percent of costs charged by Guardian Flight, the air service that provides most medevacs here.

The expiration of a five-year contract between the two companies means Apollo will cover 80 percent of Medicare rates for Guardian-provided flights beginning May 1, 2013. Medevac rates are based on destination and care needed, but generally run between $25,000 and $30,000.

Apollo medical director Eric Stirling said Apollo is “totally open” to renewing the contract, but “Guardian Flight has not been forthcoming to having a new agreement.”

Stirling was unclear about when the companies decided not to renew. “I don’t know if there’s been a formal rejection,” he said, but there hasn’t been a formal acceptance, either. Stirling said Apollo is proceeding with the appropriate planning and decision-making under the assumption the contract will not be renewed.

Noble Anderson, medical director for the Haines clinic, characterized the negotiations as a “political power play.”

“I think Guardian was charging Apollo very high rates and sticking them with very high bills and Apollo said, ‘We’re not going to play that way anymore,’” Anderson explained.

Anderson said he spoke to a Guardian representative over the summer who reassured him the issue would be resolved before May 2013.

Anderson also clarified that “80 percent of Medicare rates” does not mean 80 percent of the bill. For example, if Guardian billed an uninsured Apollo policyholder $30,000, and Medicare would normally cover $20.000, Apollo would pay for 80 percent of the $20,000.

Policyholders currently pay about $125 per household annually for medevac coverage. Apollo has become popular with residents with limited insurance coverage as a way of bridging the high cost of medevacs.

Stirling said clients whose policies are about to expire are receiving letters explaining the change in coverage. He estimated 98 percent have renewed their policies.

Apollo is advising policy holders request other carriers – such as Airlift Northwest, LifeMed Alaska, LifeFlight, and Capital City Rescue – prior to using Guardian Flight. Medevac flights through these companies are still completely covered, Stirling said.

Haines clinic administrator Marcia Scott said the clinic would try to abide by a patient’s carrier request but could not guarantee a particular provider would be used.  

“If the patient had a preference we would probably try to honor that, but it would also depend on their medical condition and the company that could get a flight here the fastest,” Scott said.

Scott said Guardian currently provides the majority of medevac services in Haines. Between October 2011 and September 2012, Guardian provided 44 of 74 medevacs. Airlift Northwest performed one. The U.S. Coast Guard and the Sitka-based SEARHC medevac accounted for the remainder.

Of the in-state medevacs, which are less expensive than out-of-state, 37 went to Juneau, 17 to Sitka, and 16 to Anchorage. The rest flew to Washington and Idaho.

One of the main reasons Airlift Northwest provides so few medevacs from Haines is because the company’s Learjet 31 can only land on the Haines Airport runway during good weather conditions. (The on;u Airlift Northwest medevac last year came in July.)

“If you have icy conditions or rainy and wet conditions, then we need more runway. On a clear, dry day we can fly up to Haines no problem,” said Shelly Deering, Airlift Northwest’s regional manager for Alaska.

Deering said Airlift Northwest is evaluating whether to station a turbo-prop – a smaller plane like the one Guardian uses – in Juneau to provide increased medevac services to Haines, Skagway, and other small Southeast communities.

“It’s something we’ve looked at in the past. We’ve actually been asked by different facilities if we would put that service in. We’ve also been asked by insurance providers,” said Deering.

Deering estimated Airlift Northwest charges one-fourth to one-third less than Guardian for flights. She also said a decision regarding the turbo-prop plane would be made by the beginning of the year, and the company would plan to have the aircraft in Juneau by April or May.