Air ambulances are used to transport patients during critical medical situations. They can be especially important in areas where ground ambulances may not be available—or in rural areas where an appropriate medical provider may be very far away.
Sky-High Prices. Recent data from the Health Care Cost Institute shows that the cost of air ambulance trips rose sharply in the last decade even though air ambulances are used less frequently. From 2008 to 2017, the use of helicopter ambulances declined by 14.3 percent while the use of airplane ambulances remained about the same. At the same time, the average price of an air ambulance trip more than doubled—rising 144 percent for helicopters and 166 percent for planes. This is consistent with a recent study published in Health Affairs, which found that out-of-network air ambulance bills averaged $91 million per year, rising from $41 million in 2013 to $143 million in 2017. The Government Accountability Office (GAO) found that the average cost of an air ambulance was about $36,000 for helicopter transport and $41,000 for fixed-wing (airplane) transport.
While air ambulance transportation can be vital for patients, air ambulance providers are a common source of surprise medical bills. These bills can be very costly for patients. Although comprehensive data is not available, the GAO found that complaints about surprise air ambulance bills were almost always more than $10,000. Another study showed that air ambulances resulted in median potential surprise bills of $21,698. And yet another study showed that 2 in 5 air ambulance transports resulted in a potential average surprise bill of $19,851.
Federal Legislation. Surprise bills from air ambulances present unique issues for policymakers. Federal aviation law currently restricts the ability of states to regulate air ambulance prices. Although state policymakers have tried to address air ambulance surprise bills, these efforts have been challenged in federal court or face significant legal hurdles. This is one reason why state insurance commissioners continue to urge Congress to include air ambulance-specific protections in any federal legislation. Given this limitation, action by Congress was necessary to limit surprise air ambulance bills.
Congress took action to protect patients from surprise air ambulance bills in the recent No Surprises Act, although those protections will not go into effect until 2022. Before that, the U.S. Department of Transportation established the Air Ambulance and Patient Billing Advisory Committee, which was tasked with reviewing policy options and making recommendations to protect patients.
Featured Resources on Air Ambulances
- Restraining Balance Billing by Air Ambulance Providers: CHIR Keeps Up with Federal Advisory Committee and Regulatory Actions (CHIRblog, 2021)
- Letter to the Air Ambulance and Patient Billing Advisory Committee (National Association of Insurance Commissioners, 2021)
- The Unfinished Business of Air Ambulance Bills (Health Affairs Blog, 2021)
- Out-of-Network Air Ambulance Bills: Prevalence, Magnitude, and Policy Solutions (Milbank Quarterly, 2020)
- High Air Ambulance Charges Concentrated in Private Equity-Owned Carriers (Brookings Institution, 2020)
- What States Can Do to Address Out-of-Network Air Ambulance Bills (Journal of Law, Medicine & Ethics)
- Most Patients Undergoing Ground and Air Ambulance Transportation Receive Sizable Out-of-Network Bills (Health Affairs, 2020)
- Solutions for Air Ambulance Surprise Billing in Holding Pattern (JAMA, 2020)
- Department of Transportation Hosts the Inaugural Meeting of Committee to Advise on Air Ambulance Billing Issues (CHIRblog, 2020)
- Air Ambulances – 10 Year Trends in Costs and Use (Health Care Cost Institute, 2019)
- Air Ambulance: Available Data Show Privately-Insured Patients Are at Financial Risk (U.S. Government Accountability Office, 2019)
- Are Air Ambulances Truly Flying Out of Reach? Surprise Billing Policy and the Airline Deregulation Act (Health Affairs Blog, 2019)
- Will It Fly? Wyoming Attempts End Run Around High Air Ambulance Prices (CHIRblog, 2019)
- Air Ambulance Service and Complaint Data (Department of Transportation, 2019)
- Letter to House Representatives from State Insurance Commissioners on Air Ambulances (National Association of Insurance Commissioners, 2019)
- Letter to Senators from State Insurance Commissioners on Air Ambulances (National Association of Insurance Commissioners, 2019)