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An ordinary day can be upended by an unexpected emergency. One minute you’re fine, and the next you’re rushed for care miles from home in an air ambulance. For many families, the medical emergency isn’t the only challenge. The medical bills can become just as time consuming. And while the No Surprises Act (NSA)* was designed to protect patients from the worst of unexpected medical costs, it’s important to understand what the limitations of the act are so you can be better prepared.
Why the No Surprises Act Exists
The No Surprises Act was created to protect patients who are covered by commercial health insurance from “surprise medical bills” — charges that remain unpaid after insurance pays and the patient pays their out-of-pocket responsibility, including a copay, coinsurance and deductible, when they receive emergency care from an out‑of‑network provider. Before January 1, 2022, patients were routinely billed the difference between what their insurance paid and assigned as the patient’s out-of-pocket responsibility, and the provider’s full charge, a practice called balance billing. These charges frequently occurred after emergencies where patients had no ability to choose their provider, including air ambulance services.
In an attempt to fix the problem of balance billing, Congress passed the NSA as part of the Consolidated Appropriations Act of 2021. It prohibits balance billing for most emergency services, including out‑of‑network air ambulance transports. Insurers and providers now must resolve payment disputes through an Independent Dispute Resolution (IDR) process, without involving the patient in the negotiations.
How Air Ambulance Billing Worked Before the NSA
Air ambulance companies sometimes bill insurance plans out‑of‑network, meaning there is no agreement on negotiated rates with insurers, and patients are responsible for more than their usual copays, coinsurance or deductibles. Insurance companies would pay whatever they deemed appropriate — often far below the provider’s charge or actual costs of emergency care — and the remaining balance was billed to the patient. Families routinely faced bills in the tens of thousands of dollars for flights deemed necessary by on-scene medical professionals. The median charge for a helicopter air ambulance for all providers in 2017 was $36,400*, highlighting just how steep these balances could be. The cost of readiness in helicopter EMS is a key factor all providers experience in determining their rates.
How Air Ambulance Billing Works Now Under the NSA
Today, when an air ambulance provider is out‑of‑network, the patient is only responsible for what would have been owed in‑network — nothing more. Balance billing is prohibited, and insurers and providers negotiate or use the IDR process to settle payment disagreements.
However, and this part is crucial; the NSA does not guarantee that your insurance company will cover your transport. If your insurer denies the claim entirely (for example, deeming the flight “not medically necessary”), you may still be responsible for the full cost of the transport. The NSA only protects you from balance billing, not from non‑coverage.
Costs the NSA Does Not Remove
Even when the NSA applies, patients may still owe:
- Copays
- Coinsurance
- Deductibles
- Full costs of care if the insurer denies the claim
All four of these remain patient responsibilities under the NSA, and many insured adults still struggle to afford high deductibles, even with protections in place.
Why Understanding Your Coverage Still Matters
While the NSA is a major step forward, it still doesn’t eliminate financial risk. Air ambulance transports are lifesaving, but they are also costly across all air ambulance providers who must operate and maintain expensive equipment to be ready 24/7/365 — and denials of coverage are rising nationwide. Knowing your insurance coverage details, denial rates, and what protections exist can help your family prepare before an emergency ever happens.
How to close the NSA’s Financial Gaps
Membership programs like AirMedCare Network can offer additional peace of mind by eliminating out‑of‑pocket costs only when transported by a network provider, even if insurance denies the claim and your protections under the NSA don’t exist. Air ambulance care is lifesaving in rural areas and health care deserts where air transport may be the only option. Learning about membership programs that can make air ambulance billing more affordable and predictable can help families not fall through the financial gaps in NSA protections.
Key Takeaways about the No Surprises Act
- The No Surprises Act (NSA) protects patients from unexpected air ambulance bills, but copays, coinsurance, deductibles, and denied claims can still leave patients with significant out-of-pocket costs.
- Many insurance companies deny to cover their portion of air ambulance care, so insured individuals may struggle with high deductibles and medical expenses, even with NSA protections in place.
- Understanding the details of your insurance coverage, including what is and isn’t protected, is essential to minimize financial risks during emergencies.
- Air ambulance transport is especially critical in rural areas and health care deserts, but coverage denials are on the rise, increasing the need for proactive financial planning.
- Membership programs like AirMedCare Network can help fill the gaps left by the NSA, offering additional peace of mind by covering out-of-pocket costs when transported by participating providers.