Imagine you’re on a ladder taking down Christmas lights, cleaning the gutters or doing routine house maintenance when it happens. You wake up in pain and have strange sensations in both of your legs. Your spouse has called the local ambulance company but because of the height of the ladder and the strange sensations, the ground crew calls for an air ambulance to take you to a trauma center that’s 80 miles away.
Household slips and falls are common, but they can quickly become dangerous when they happen from a height. In emergency medicine, a household accident might just mean a simple trip to the ER, but a fall from a significant height can meet trauma criteria. Even when patients meet trauma criteria and are taken to a trauma center, they sometimes turn out to have less serious injuries than expected.
The patient in this scenario may simply have pinched a nerve or suffered severe bruising and would be treated and released on the same day. The injury initially appeared to require trauma care, but after evaluation, it was found to be much less serious than originally believed. In these cases, patients may encounter a denial of coverage from their insurance for their air ambulance flight.
Every year, thousands of patients face insurance denials or hefty air ambulance bills for various reasons they were not anticipating. Many mistakenly believe that laws like the No Surprises Act guarantee protection from steep charges. In truth, there’s a lot of confusion about air ambulance billing and insurance coverage—information you should know before you ever need an air ambulance.
The No Surprises Act and Air Ambulances
The No Surprises Act (NSA) does not eliminate costs for patients who need air ambulance transport despite rampant misconceptions. The law can be confusing, but here’s the main point: the NSA applies to commercial insurance plans and eliminates balance billing for covered services. The NSA does not guarantee insurance coverage for the air ambulance bill. If your insurance company denies your claim, you will have to pay the full bill yourself. This applies even if you have private insurance or Medicare.
The NSA does not set the price for air ambulance services. It does protect you from “out-of-network” charges. This means you pay the same amount out-of-pocket no matter which provider transports you. The NSA does not apply to ground ambulance services. If both air and ground ambulances services are provided, you may be billed for both types of transport.
Your out-of-pocket expenses for air ambulance care depend on your insurance policy. If your claim is not denied, you will pay your deductible, coinsurance and any co-pay required by your plan. Hypothetically, if your air ambulance bill is $40,000, your deductible is $5,000, and you are responsible for 20% coinsurance after the deductible, you would pay $5,000 plus 20% of $35,000 ($7,000), totaling $12,000 out-of-pocket.
To avoid unexpected expenses, review your insurance policy carefully and contact your provider to clarify what is covered before an emergency occurs.
Denials of Coverage for Air Ambulance Care
A 2023 Kaiser Family Foundation study found that 18% of all insurance claims were denied by insurance providers. Since then, the rate of denials has steadily increased. If you are involved in an accident and transported by air ambulance, and it is later determined that your injuries did not meet trauma criteria, you may face a total denial of insurance coverage. This would leave the patient responsible for the entire air ambulance bill. This is especially concerning because patients cannot make an informed decision at the time of an accident due to stress or incapacity, and they may not have the medical knowledge to make the right choice for their wellbeing. As mentioned before, the NSA does not protect patients against denials of coverage.
How to Financially Protect your Family
Choosing to protect your finances against potentially high air ambulance bills through membership is a proactive decision that can easily pay for itself with just one transport. In your area, access to trauma centers or even emergency rooms may require air ambulance transportation when time is a critical factor in your care.
There may be one or two air ambulance providers in your area, and it is wise to determine if both offer low-cost membership. Benefits vary between companies—from partial responsibility for the bill to limits on the number of transports per year. With AirMedCare Network (AMCN), you will never bear any out-of-pocket expense for your care, and there is no limitation on the number of annual transports with our providers. If you are uninsured, experience a denial of your bill or have large deductibles, co-pays, and coinsurance, AMCN membership provides peace of mind beyond the limited protections of the NSA.
NSA and Air Ambulance Bill Key Takeaways
- No Surprises Act (NSA): The NSA applies to commercial insurance plans and eliminates balance billing for covered services but does not guarantee insurance payment or set prices. Patients may still face full costs if services are deemed not covered by their plans.
- Out-of-Pocket Costs: Even with insurance, deductibles, coinsurance and co-pays can result in significant expenses. Reviewing your policy in advance is crucial.
- Denials of Coverage: Insurance denials are rising, especially when air ambulance transport is deemed unnecessary. The NSA does not protect against this risk, so patients could be liable for the full bill.
- Financial Protection: Air ambulance memberships, like with AMCN, can cover out-of-pocket costs and provide security if a denial or high bill occurs.
Taking proactive steps—such as understanding your insurance and considering a membership plan—can help guard against major, unexpected air ambulance costs.
* https://www.kff.org/private-insurance/claims-denials-and-appeals-in-aca-marketplace-plans-in-2023
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