Air Ambulances: What You Need to Know

Air ambulance providers play a vital role in Montana’s health care system. Whether it’s rescuing an injured hiker from a mountain peak, or flying a critically ill infant to an out-of-state specialty care hospital, an air ambulance flight can mean the difference between life and death. These providers enable Montanans to access timely, quality medical treatment.

But air ambulance transports are also very expensive. A typical air ambulance charge runs into the tens of thousands of dollars. Some health insurers and air ambulance providers have reached reimbursement agreements that protect the patient from excessive charges. But in many cases, there’s a big gap between what the provider charges, and what the insurer pays. And the result is usually a big out-of-pocket charge to the patient who took the flight.

This website provides answers to frequently asked questions and shows whether a provider is in your insurer’s network.


Frequently Asked Questions

Here are some questions consumers often have when it comes to air ambulance flights. You can also call the Office of the Montana State Auditor, Commissioner of Securities and Insurance at (800) 332-6148 for further assistance.

Most major medical insurance policies and employee benefit plans provide some form of air ambulance coverage. However, the policy may not cover the entire charge, and could even leave you with a large amount owed out of pocket. Here are a couple of important factors that can have a huge impact on your air ambulance bill.

  • Provider network: It’s important to know which air ambulance providers are “in-network” under your insurance policy or employee benefit plan. In-network providers agree to accept a set allowable amount as payment in full, but you are typically still responsible for any deductibles, copays, and coinsurance. Most Montanans live within range of an in-network provider. “Out-of-network” providers have not agreed to the allowable amount, and will require you to pay the balance of the charged amount left over after your insurer or plan pays its portion. This is often referred to as a “balance bill,” and can reach tens of thousands of dollars.
  • Cost sharing: Regardless of whether you use an in-network or out-of-network air ambulance provider, you’ll still likely be responsible for your usual cost sharing obligations under the policy. These include your deductible amount, any copayments, and any coinsurance (a percentage of the amount owed after deductible and copayments). Even with an in-network provider, you may still have a significant out-of-pocket expense.
For emergency transports, you do not need to request preapproval by your insurer or employee benefit plan. However, preapproval may still be necessary for non-emergency flights.

If you have time, it is always a good idea to contact your insurer or plan to learn about your air ambulance provider network, what you can expect to pay out of pocket, and other coverage details.

If your health insurer or employee benefit plan denies payment for an air ambulance claim, you have the right to appeal the decision with your insurer or plan. In most circumstances, after the appeal process is complete you can also request that an impartial third party review your insurer’s determination and, if appropriate, require the insurer or plan to pay the claim. Instructions on appealing a claim denial are located in your insurance policy or summary plan description, as well as the explanation of benefits you receive.

You can also contact the Commissioner’s office for assistance in appealing a claim at (800) 332-6148.
Click here for more information on your appeal rights.

Some air ambulance providers sell memberships. The benefit of a membership is typically that a member who is transported by that provider will not incur any out-of-pocket expenses. Members pay an annual fee, and the membership often covers them as well as their families.

Things to keep in mind:

  • If you have a membership, it’s only effective with that provider and any other providers with whom there is a reciprocity arrangement. If another provider is called, you’ll be on the hook for unexpected out-of-pocket expenses.
  • Under Montana law, air ambulance providers are required, to the extent reasonably possible, to enter into reciprocity arrangements with other providers, meaning the providers honor each others’ memberships. However, this doesn’t always happen; be sure to check with your air ambulance provider.
  • Air ambulance providers have limited service areas. If you need an airlift while traveling, for example, it’s unlikely your membership provider will be providing the service. Also, some air ambulance providers have been known to market their memberships in geographical areas they don’t even regularly service.

Keep in mind, the patient usually isn’t capable of requesting a specific air ambulance provider, whether due to injury or the fact that a hospital or 911 dispatcher is making the call.

No. Air ambulance providers can vary in several respects. A number of factors affect when and how far an air ambulance can transport a patient, as well as the level of care they can provide.

  • Emergency vs. non-emergency: Some air ambulance providers perform emergency services, non-emergency services, or both.
  • Helicopter vs. Airplane: Some air ambulance providers have both helicopters and airplanes available, while others have one or the other.
  • Staffing and equipment: Most air ambulances come with one or more medically trained personnel and some degree of medical equipment. However, some air ambulances may be equipped and staffed to provide specialized services (such as neonatal intensive care), while others (such as nonemergency transports) may not have the specialized staff or equipment for certain types of transports. Also, some, but not all, providers have flight crews available 24 hours a day.
  • Licensing: Montana law requires air ambulance providers operating in Montana to be licensed; some abide by this requirement, while others choose not to follow Montana law on this point.
  • Accreditation: Many air ambulance providers are accredited, meaning they meet a comprehensive set of safety and patient care standards established by an accrediting body. The most common accreditation standard is CAMTS. If your air ambulance provider isn’t accredited and you have time, it’s a good idea to research the quality of the provider’s level of training and scope of practice.
An emergency medical condition is one that could reasonably be expected to result in serious jeopardy to the health of the patient or her unborn child; serious impairment to bodily functions; or serious dysfunction of a bodily organ or part.

If an emergency medical condition exists, an air ambulance provider may not consider the patient’s insurance status or other ability to pay. Likewise, an insurer or employee benefit plan may not require preapproval of an air ambulance transport in an emergency situation. In an emergency, the patient usually does not have the opportunity to request transport by a specific air ambulance provider.

Different rules apply in a nonemergency. The air ambulance provider is allowed to consider the patient’s ability to pay, and may require payment in advance. Your insurer or employee benefit plan may not cover a nonemergency transport, particularly if that transport is not considered medically necessary. However, in a nonemergency scenario, the patient or patient’s family is able to shop around for the most affordable air ambulance transport, preferably from an in-network provider; a hospital case manager can assist with this process.

Emergency Care Provider
An air ambulance that transports a patient from the scene of an accident most likely was requested by an on-scene emergency care provider.

The Treating Physician
For a hospital-to-hospital transport, the treating physician will decide whether an air ambulance is needed, and which to use.
Depending upon the urgency of the transport to stabilize a patient a doctor might speak with the patient’s family about transport options and preferences on the hospital to which the patient will be transported.

The following situations are possible:

A patient covered by Medicare is responsible for the deductible and coinsurance unless that patient’s Medicare supplemental policy covers the non-Medicare-covered costs.

If you have health insurance or are covered by an employee benefit plan, you will be responsible for any applicable deductibles, copayments, and coinsurance. Ask your insurer if it has in-network contracts with certain air ambulance providers. If the air ambulance provider is not “in-network,” you will also be responsible for the balance of what the insurer or benefit plan does not pay.

If you have a membership with an air ambulance provider, ask the hospital staff if they are going to call that provider. If not, check to see if your membership has “reciprocity” with the transporting air ambulance provider (meaning the other company has agreed to honor your membership terms).

If you do not have health insurance, Medicare, Medicaid, or a membership, you face the full cost of whatever the air ambulance determines is the charge. A private air ambulance company may have payment or charity care terms. An air ambulance affiliated with a hospital has a charity care policy.