Prices for emergency medical flights are rising along with cases of Covid-19

Emergency transportation.
Emergency transportation.
Image: Reuters/Paul Ratje
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Respiratory disease and Covid-19 are, respectively, the first and second most common diagnoses of patients who required emergency medical flights in the US, according to a report published last week by Fair Health, a nonprofit organization focused on transparency in healthcare costs.

Between 2016 and 2020, the three most common causes for people transported on medical airplanes or helicopters were digestive system issues, heart attacks, and sprains or fractures. But in 2020, 18% of patients who needed medical flights were affected by respiratory diseases, including 7% who were eventually diagnosed with Covid-19.

Something else about air ambulances also changed between 2016 and 2020—the price. In 2016, the average cost of a medical flight on an airplane was $19,200; in 2020, it was $24,500, or nearly 30% more. For helicopters, which are the more common means of air transportation for emergency medical patients, the prices were even higher, rising from $25,000 for a flight in 2016 to $30,500 in 2020, an increase of more than 20%.

The rise in price is even more remarkable when looking over a longer period: Between 2008 and 2017, the cost of medical helicopters tripled, from a median of $12,500 to nearly $36,000, according to the Health Affairs, a healthcare journal. Overall, government research found, the cost of all medical air transportation doubled between 2010 and 2014, as available medical air transportation grew. These prices far exceed the actual costs of operating medical flights.

Up to 77% of air ambulances (both planes or helicopters) are billed as out-of-network, which exposes patients to serious risks of high medical spending, and potential debt.

Why are medical flights so expensive?

Medical air transportation is very costly, but also very rare. In the US, less than 1% of emergency transportation happens via air, but the use of medical flights has been growing steadily in the past few years, increasing 30% between 2016 and 2020. This means that insurance companies don’t have incentives to engage in heavy negotiations, but are willing to pay the odd steep bill, especially since the balance is typically passed onto the patient, according to Health Affair’s analysis.

Further, the market for medical air transportation is very concentrated. According to research by the Brookings Institute, two-thirds of all helicopters and planes used for medical transportation belong to only two, private-equity-backed companies. These companies charge on average three times as much as municipally-owned carriers, for helicopter transportation and more than five times as much for helicopter transportation.

Due to a lack of competition, providers tend to keep their services out of network, preferring to charge patients the full price they have set for their services rather than a lower fee negotiated with insurers. Further, medical flights typically come into play in situations where patients scarcely have the time to shop for a better price, and even if they were, the fact that companies don’t have to disclose their prices hinders any possibility of negotiation.

Can air ambulances surprise bill?

Surprise bills from medical flights can be steep, and are relatively frequent considering how often the services are out-of-network. This might change in a few months, when the No Surprise Act comes into effect Jan. 1. The law bans billing for out-of-network services provided in emergency situations above what would be paid for in-network service.