GAO: Air ambulances can come with big surprise bills—even for patients with private insurance


Getting a ride in an air ambulance during an emergency can help save a patient's life.

But it can also saddle them with seriously big bills, even if they have private insurance, according to a new report from the Government Accountability Office (GAO).

The GAO looked at nearly 21,000 air ambulance transports in 2017 and found nearly 70% were out of network. In comparison, research has previously shown that about half of all ground ambulance transports are out of network. 


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Air ambulance providers respond to emergencies without knowing patients' insurance coverage. Here's a breakdown of helicopter transports by payers.
  • 35% are for Medicare patients
  • 32% are for privately-insured patients
  • 21% are for Medicaid patients
  • 9% are uninsured

Source: GAO

Out-of-network transports may result in balance billing, or surprise billing, which is the passing of the difference between what insurers will pay and hospitals’ list prices to patients. GAO's analysis found the median price charged by air ambulance providers was about $36,400 for a helicopter transport and about $40,600 for fixed-wing transport. 

That was an increase in price of more than 60% from 2012 when the median price for a helicopter transport was $22,100. 

RELATED: Taken for a ride: After ATV crash, doctor gets $56,603 bill for air ambulance trip

In one example, a North Dakota patient received a balance bill for about $34,700 after an air ambulance provider charged $41,400 for transporting that individual from Dickinson to Bismarck. The insurer was only willing to pay $6,700 for the ride.

Maryland had about two dozen complaints over balance bills ranging from $12,300 to $52,000.

"Relatively few patients receive air ambulance transports, but those patients who do generally have no control over the decision to be transported by air ambulance or the selection of the air ambulance provider," the GAO wrote in the report. 

While Medicare and Medicaid prohibit balance bills being sent to patients, patients with no insurance might be held responsible for the full price charged for transport and insured patients get a balance bill.

What can be done

States may be blocked from doing something about the problem. Specifically, the Airline Deregulation Act of 1978 blocks states from regulation rates or services of air carriers. The Employee Retirement Income Security Act of 1974 (ERISA) allows states to regulate health insurers but blocks them from directly regulation self-insured employer-based health plans.

RELATED: Hospitals struggle to afford air ambulance services

The GAO pointed to a request of the Department of Transportation (DOT) in 2017 to address the problem. So far, the DOT has taken steps to make it easier to register complaints about air ambulances and listed the monthly number of air ambulance complaints filed since January 2018.

However, the DOT has not yet assessed available federal and industry data to determine what information could assist in the evaluation of future complaints and considering consumer disclosure requirements for air ambulance providers, such as established prices charged or insurer contracting information.

A bright spot in the report: The GAO reported those figures may have improved since 2017 because air ambulance providers indicated they were entering into ore network contracts recently. They also indicated they encourage patients to appeal their bill to their insurer and may give patients a break if the appeal is unsuccessful. One provider, for instance, said they offer a discount of up to 50% off the balance bill if they pay the remaining 50% immediately.

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