This case provided unique challenges due to the initial poor prognosis of the patient, a long and turbulent hospital stay, a recovery to discharge and a repatriation air ambulance flight to reunite the patient with his family in the US.
The initial request to AMREF Flying Doctors (AFD) was to arrange for a commercial ticket for the patient and his wife from Entebbe, Uganda to Nairobi, Kenya. The patient had been diagnosed with Covid pneumonia in early January 2021, and had home-based care for the first eight days. After failing to improve, he was admitted to a local facility in Kampala. Due to declining oxygen levels, he required intubation and ventilation 48 hours before transfer to Nairobi. AFD assisted with obtaining a pre-flight medical report to assist the patient’s insurer in obtaining an acceptance letter into the hospital in Nairobi (a mandatory requirement for medevac clearance from the government authorities).
Crucial financial decisions
As an accredited service provider for assistance services, AFD conducted the medevac and requested a Guarantee of Payment (GOP) to cover medical expenses for one week at the hospital in Nairobi. The requirement to increase the cost of coverage necessitated a lot of back-andforth communication with the assistance partner, who in turn had to seek authorisation for coverage from the primary insurer. The patient was admitted into the intensive care unit and given how critical he was, it was impossible to estimate the hospital length of stay. However, this is a very significant question asked by the assistance partner on a near-daily basis. His journey to recovery would be lengthy; he would require dialysis almost daily as he was in kidney failure and had already developed complications brought on by Covid-19. It was crucial for AFD to ensure that there was adequate cost coverage for the patient’s hospitalisation. AFD kept the assistance company updated on the interim medical costs, which continued to escalate by the day. The admitting hospital was a private facility and thus had very high costs for the region. The patient’s wife and daughter, for whom AFD had booked hotel accommodation, were anxious to get back home after being in Nairobi for almost two weeks. The family was very cognisant of the guarded prognosis of the patient. They at times felt compelled to have the patient repatriated back home even though he was unfit for flight. The patient’s prolonged hospital stay resulted in an accrued hospital bill of over US$300,000.00. This amount was invoiced to the requesting assistance partner in intervals, enabling AFD to pay the hospital in instalments and manage cash flow prudently.
Patients face challenges getting released from hospitals in the region without the medical bills being guaranteed. AMREF FD ensured that there would be no hindrance related to the patient’s discharge. It was also noted that many health insurers were not covering Covid-19-related medical admissions at the time, thus the hospitals were keen to ensure that these patients had adequate medical cover.
As the patient was not fit enough to fly commercially, repatriating the patient back home became a priority once he had shown signs of adequate recovery. A decision was made to repatriate through air ambulance. AMREF Flying Doctors began to consult with other providers with whom a wing-to-wing transfer could be done. The patient was twice considered unstable for repatriation until he took a good turn and began to show signs of stability and a slow but gradual improvement. AFD took advantage of the window of opportunity and arranged for the patient’s repatriation back to the US. The patient was flown from Nairobi in May 2021 on AFD’s air ambulance jet to Istanbul, Turkey, where the wingto-wing transfer occurred. The patient was then transferred safely to his home country. Effective and timely communication between the care providers at the hospital, the assistance company as the client, and AMREF Flying Doctors as the assistance service provider, helped facilitate efficient and well thought out decisionmaking all in the best interest of the patient. The AFD team ensured that the insurance company was fully informed of the patient’s clinical condition and his level of readiness for repatriation, through follow-up of the patient’s medical reports as well as bedside visits by AFD doctors and nurses.