Best Medical Evacuation
Based on In-Depth Reviews

Picture it: you've been planning a hiking trip in the Utah desert for months now. You made sure to pack all the essentials and you brought along a hiking buddy, because you know better than to go to remote locations by yourself. Now, hours into your hike, you come across a gap between rocks that you have to jump across. Your buddy clears the gap effortlessly, but when it's your turn, the unthinkable happens: you slip and fall down the small canyon, breaking a few bones in the process.

The situation looks dire, but luckily, your cell phone service registers the barest of signal bars. Your buddy phones emergency services to request an ambulance, but they say it will take at least two hours to reach you. As you and your friend pass the time waiting in the baking sun, you start hearing what sounds like helicopter blades in the distance. You look up to the light and see your ambulance touching down from the skies to get you to safety.

While that was a hypothetical scenario, the truth is that thousands of people are in need of search and rescue (SAR) operations every year in the U.S. A 2017 report by the National Park Service (NPS) shows that at least 4,194 SAR operations were carried out in that year alone, with many others presumably unreported. Some—like the woman who fell down a ravine while snowmobiling in Yellowstone National Park—required medical air transportation to provide them the necessary treatment while en route to the hospital. However, while air medical transports are in many ways functionally similar to conventional ground ambulances, they have some notable differences.

What Are Medical Air Transports?

Air medical transports are meant to reach you where a more traditional ground ambulance cannot. If you suffer a traumatic injury while hiking, rock climbing, or any similar activity in locations that would prevent ground transports from reaching you in a timely fashion, an air ambulance will likely be deployed. Whether an injury results  from a construction accident, a traffic collision, or, who knows,a cartoonish baby grand piano being hoisted up the sides of a building suddenly falling on someone—it can all require the use of an air ambulance, if the injury is severe enough.

However, medical air transports are not exclusively used for extreme outdoor activity injuries or unexpected life-threatening injuries. They can also be used so that anyone who lives too far away from the nearest hospital, such as in underserved rural communities—which have seen over 83 hospital closures since 2010—can receive the urgent care they need in a timely fashion. They also help transport patients who are travelling abroad and cannot afford or are not allowed to receive treatment in the countries they are travelling to.

Not All Ambulances Are The Same

Despite the fact that medical air transports are essentially air ambulances, their relationship with your medical insurance provider is not quite as straightforward. Most of these transports are operated by private companies, which form agreements with different insurance providers, meaning that no single insurance provider will consider all medical air transport services to be in-network.

As many with private health insurance have found out at some point, out-of-network services end up being far more expensive than those covered by your provider. While many private health insurance providers include ground ambulance coverage in some form or another, air ambulance services are not included with every type of plan. Your first step when considering air ambulance coverage is to check with your insurance provider to see if your plan includes medical air transportation, and whether you can add it to your plan if you don’t already have it. 

However, even if it is included, you still have to read the fine print and understand the terms of service, since air ambulance services are only covered when they’ve been designated as “medically necessary,” the definition of which may vary from insurer to insurer. This can be further complicated by the fact that you seldom have a choice in which medical air transportation company is called to pick you up in an emergency, which could mean using an out-of-network provider, and result in astronomical bills.

The problem with balance billing

A report by the Government Accountability Office estimates that as of 2014, the average cost of an air ambulance ride was $30,000, with some companies charging an average of $49,800 in 2016. If you’re fortunate enough to receive services from a company that works with your insurer, its full cost will likely meet your deductible and out-of-pocket maximums, but you will not receive a bill for the difference other than your co-insurance payments. If on the other hand, you fly with an out-of-network provider, you may be subject to a practice called balance billing, which makes you liable for the remaining portion of the bill that your insurer did not cover.

The amounts that you can be liable for may reach the tens of thousands of dollars, as one man in Texas found out. In this instance, the total bill for the transportation was $56,603, but his insurance company only covered $11,972, leaving him with a total bill of $44,631. Although the man in question has managed to have his insurer negotiate the remainder of the bill with the air ambulance service, many others are not so fortunate. Even when they’re not supposed to, many people still receive balance bills when receiving in-network services. In the event that you find yourself in such a situation, the National Association of Insurance Commissioners recommends reaching out to your state’s local insurance department in order to have the situation resolved.

While states’ rules in regard to balance billing for the privately insured vary, Medicare and Medicaid enrollees are protected from the practice altogether. A 2019 report from the Centers for Medicare and Medicaid Services outlines the general statistics surrounding air ambulance use as well as underlining the fact that regardless of the circumstances, air ambulance providers are expressly forbidden from charging anything beyond standard fees such as copayments and coinsurance.

Preparing For The Unexpected

Even if your medical insurance covers medical air transport, most, if not all, insurance companies only cover flights to the nearest serviceable facility. That means that they will not fly you to the hospital of your choice or a hospital in your network if the situation is urgent. Additionally, repatriation services—meaning medical air transportation back to your home country if you were travelling abroad—are seldom offered with traditional insurance plans. Partly due to this, air ambulance companies offer standalone memberships that cover the full cost of transportation and treatment during the flight to a hospital of your preference.

If you opt for one of these memberships, it is very important to make sure the company of your choice has a solid customer support team, as they will be the ones in charge of finding the nearest hospitals in your network if a time-sensitive situation arises.

Fleets: helicopters vs jets

Another thing to keep in mind when deciding which, if any, medical air transport company to choose is their composition of their fleet. Medical air transports come in two varieties: fixed wing (airplanes) and rotary wing (helicopter.) Many private and public providers have fleets composed of both types of aircraft, though this is not always the case, and while both types of aircraft have their pros and cons, it is important that the provider you choose has a fleet that best serves your needs.

Both types of craft require that your flight be further than 150 miles from the point of pickup to the hospital that will be treating you, but they have very different space considerations when it comes to takeoff and landing. Fixed wing craft will require a runway in order to touch down and take off, but are considerably more stable during flight. Rotor wing craft are able to reach more difficult terrain, but their flight distance is more limited and their cabins cannot be  pressurized, which can be hazardous for persons with specific injuries or conditions that require stable air pressure.

A general rule of thumb to follow is, if you live near any airports or airstrips, or are travelling abroad, a company with fixed-wing aircraft might be more useful to you. If, on the other hand, you live in either a mountainous area, a rural area without access to airports, or an area prone to severe traffic jams, a company with rotary wing craft might be better suited for your needs. In practice, if you really feel like you’ll need to make use of air ambulance services, it’s best to choose a company that has both types of craft in their fleet, as you never really know which one you’ll need in an emergency.

Accreditations: What Are They Good For?

Another factor when considering a membership with a particular air medical transport company is reviewing which, if any, accreditations they currently hold. Since the industry in the U.S. is currently unregulated at the federal level, it falls to individual states and independent organizations to conduct oversight and draft operational standards.

Due to the language used to draft the Airline Deregulation Act of 1978, states have been largely unable to pass any sort of meaningful legislation with regards to the air medical transport industry. The National Association of State Emergency Medical Services Officials, in conjunction with state officials, has managed to build a basic framework for enacting said legislation, which at the very least would guarantee minimum standards of training and qualifications. 

That said, the few states that have drafted any sort of guidelines for the industry have done so by deferring to the Commission on Accreditation of Medical Transport Systems’ (CAMTS) own guidelines. CAMTS, along with the European Aero-Medical Institute (EURAMI) are currently the largest organizations in charge of standardizing air medical transportation certification criteria across most of the world.

It is important to note that while these organizations take great care to ensure the highest standards of medical service during an air ambulance ride—in the U.S. at least—they are still unable to enact significant protections for consumers when it comes to the cost of the service.