Air Ambulance

An air ambulance is a helicopter or fixed-wing aircraft that carries a patient to a hospital when time or distance makes a road trip unsafe: a highway crash in West Texas, a stroke in a town whose hospital has no neurologist, a newborn who needs a NICU. About 550,000 patients a year are flown in the United States. It is also the most expensive ride in healthcare, with average charges above $30,000 per flight and many bills above $50,000, and until 2022 the patient often owed most of it.

The reason the bills were so large is that most air ambulance companies are out of network with most plans, and federal aviation law kept states from regulating their prices. A Government Accountability Office study found two-thirds of flights were out of network, with a median charge of about $36,000 and a median plan payment of a fraction of that. The No Surprises Act changed this on January 1, 2022. For an air ambulance flight, the patient now owes only in-network cost sharing, and the plan and the air company settle the rest through the federal dispute resolution process. Air ambulance has been the largest category in that process by dollars, with providers winning most disputes at amounts several times the Medicare rate, which is why plan premiums still feel it. The law does not cover flights arranged for a non-emergency without prior approval, and it does not cover ground ambulance at all.

The takeaway: if you receive a large air ambulance bill for an emergency flight after 2022, it is almost certainly a mistake or a violation. Call your plan, cite the No Surprises Act, and file a complaint at cms.gov/nosurprises if the company will not withdraw it.