The rising cost of medical care is now in the skies above us.

That’s what one Citrus County resident discovered after her husband’s bicycle accident, and subsequent medical evacuation to Shands hospital in Gainesville. But her lesson is also shared by the county itself -- which has the same insurance carrier, Blue Cross and Blue Shield.

Donna Nichols of Homosassa, who appealed for help to the county commission on Tuesday, is facing a bill for $11,000 after Blue Cross only paid for $5,000 of the costs. She and her family are on the hook for the balance. She told county commissioners that the aviation company behind Tampa General Hospital’s Aeromed 3 helicopter -- Rocky Mountain Holdings -- insists she pay what Blue Cross won’t.

Her options have been to pay $10,000 in 10 business days or $202 per month for four years. And that situation is on top of a previous medical difficulty she had previously been through -- having suffered costs associated with her husband’s open-heart surgery.

“I’m here to ask help from the board, not only for my family’s financial survival, but also for the financial survival of families like mine who may find themselves in this situation,” Nichols said. “The three largest employees in this county -- the school board, the county, Progress Energy -- all are on Blue Cross Blue Shield. So the financial hardship I have experienced could affect all of us here right now.”

Perhaps it was coincidence, but Aeromed’s five-year contract was up with the county, and the company on Tuesday was asking that the contract be extended another five years. Their representative, Jim Scott, a program manager for Aeromed, faced a bevy of questions from commissioners about not only Nichols’ situation, but the cost of providing aerial medical services for the county.

“Unfortunately, this is something that not only Tampa General’s Aeromed is facing, but the nation is facing as it relates to health care costs, and it’s out of control, I do agree,” Scott said. He added that he didn’t want people have to need health care or suffer financial difficulty, but noted that high costs were part of doing business.

Those “preferred providers” normally making up the bulk of business come from Medicare and Medicaid, Scott said, not insurance companies such as Blue Cross. The cost of providing medical care to those who can’t afford it is made up by people who have insurance, Scott said. And it costs a lot of money to operate helicopters and have proper medical care aboard the craft, he said.

Meanwhile, insurance companies have apparently not considered the high costs of medical care associated with such things as medical airlifts, Scott said.

“I would think that, when it comes to insurance companies, there is room for a lot of negotiation,” Scott said. “Unfortunately, what we see across the country with a lot of insurance carriers is they never even thought of that process (air medical evaluation).”

As suggested by local attorney Clark Stillwell, who was also present at the commission meeting for a separate matter, the county might want to consider joining in insurance coverage with Citrus Memorial Hospital and the school board to get negotiation leverage when it comes time to renew insurance coverage.

“I may not have the solution for this family (the Nicholses), but I hearken back to the last time you negotiated your Blue Cross Blue Shield contract (and they were asked), ‘Do you reimburse physicians, hospitals and citizens in Citrus County the same way you do in other counties in the state of Florida?’

“And the young lady (Blue Cross Blue Shield representative) unequivocally said, ‘Yes we do.’ Well, no they don’t. ” Stillwell told commissioners that Blue Cross Blue Shield’s reimbursement rates differ from county to county, and that perhaps the reason why the reimbursement rate was higher in some counties, jurisdictions and individual contracts is because they had more people being insured in those counties.

The plight of the Nichols family is the tip of the iceberg, as noted by County Commissioner Joe Meek.

“Bargaining from a position of strength is easy to do,” Meek said. “And that’s why when Medicare and Medicaid tell Aeromed, or whoever it may be, ‘We’re going to give you $5,000 and that’s it,’ they say ‘Thank you.’ But when the Nicholses say now, ‘How about $5,000? they say, ‘No. We’re going to go after you,’ and they do.”

The bigger picture, Meek said, is that the county needs to address a broader policy in ensuring access to appropriate insurance availability for the county and its residents.

To Ms. Nichols, Meek expressed his regret that there was nothing the county could do to address her particular issue with the company.

“I wish we could do more,” Meek said.

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