Here’s how it works.

A doctor at a hospital or first responder at the scene of an accident decides that a patient must be transported by helicopter with the highest level of care during the flight.  Air medical services respond to that patient immediately.

The issue: The Airline Deregulation Act (ADA)


FICTION: Air medical exemption from the ADA will not change how air medical services currently operate.

ADA exemption will reduce access to air medical services and increase costs by allowing each state to regulate air medical services based on arbitrary state, county, or municipal preferences. The resulting patchwork of inconsistent regulations would make it much more difficult for air medical providers to get patients to the best, closest medical facility in an emergency.


FICTION: Air medical exemption from the ADA will not prevent air medical providers from transporting patients across state lines.

If individual states are allowed to enact their own regulations, these regulations can vary from state-to-state and affect everything from equipment on board the aircraft, how the aircraft are operated, where the control center is located, and medical staffing. Air medical providers, unable to comply with a set of inconsistent regulations for a flight that would cross state lines, would be forced to transport patients to in-state facilities which might not be the closest or most-appropriate for the patient’s needs.

Recent attempts to exempt air medical services from the ADA would only allow insurers to dramatically reduce the already decreased payments for air medical transport services. Bad for the patient, good for the insurer.


FICTION: Congress never intended to include air carriers engaged in air medical transportation in the Airline Deregulation Act.

Air Medical transport was clearly contemplated in the discussion of the ADA. A Senate floor colloquy directly discussed “the need for air ambulance services” during debate on the ADA on April 19, 1978. State authority over health care aspects of air medical transportation is clearly preserved and delineated under the ADA. Any statement that the ADA is being used beyond its intent is patently untrue.


FICTION: If air medical services were exempted from the ADA, air ambulances would still be able to respond to the nearest patient and deliver them to the nearest appropriate facilities.

By exempting air medical services from the ADA, state officials can pass laws and regulations that direct patients to in-network hospitals using in-network air medical services. In states that have attempted these types of regulations, doctors and first responders would have been required to choose providers and hospitals based on in-network insurance agreements, NOT what is best for the patient. The ADA protects patients from these types of regulations.

The issue: Perceived Price Hikes and Balance Billing


FICTION: The practice called “balanced billing” by air medical providers takes unfair advantage of patients in their time of need.

When requested by a physician or first responder, air medical providers respond immediately — without ever knowing how, when, and if the service will be paid, yet incurring all the costs associated with the flight.

Medicare only reimburses about half of the cost for a flight, Medicaid even less. That leaves commercial insurance reimbursement that varies widely across the country. Sometimes we’re paid fairly and reasonably by commercial insurance; increasingly, however, we’re not. The economics are unsustainable.

2 things need to happen:

  1. Congress needs to fix the root cause of this issue – outdated Medicare
    reimbursement to more accurately reflect the current cost of the service.
    H.R. 3378/S.2121.
  2. ALL private insurers must negotiate fair and reasonable in-network agreements
    with air medical providers in their service area. Insurance companies must
    do right by their beneficiaries who have been investing in a policy for years
    that is supposed to cover emergency care.


FICTION: Air medical companies prefer to stay out-of-network to hold out for higher commercial insurance reimbursement.

Air medical providers would much rather negotiate fair and reasonable in-network insurance agreements in the interest of protecting their patients, stabilizing operations and easing the administrative burden of claims processing. Air medical providers have entered into successful in-network agreements across the country, but unfortunately, in some markets, commercial insurance carriers are unwilling to pay or contract at rates that even cover air medical providers’ most basic costs, placing more burden on the insured patient.

The issue: An overabundance of aircraft


FICTION: The US air ambulance fleet has doubled in size in the past 15 years, resulting in a glut or over-saturation of helicopters.

Growth in the number of helicopters has been flattening, industry-wide. Any growth of the air medical transport industry has resulted from consumer demand for access to healthcare as more and more rural hospitals across the country close their doors. Air medical services are often the only way patients in an emergency can access the care they need in a timely manner.

“The growth in the number of helicopters and their
movement into communities have generally made
them more available to those in need.”
– Effects of Industry Changes on Services Are Unclear” GAO-10-907

FICTION: Investors lured by the industry’s rapid growth have acquired many of the biggest air  
ambulance operators, leaving control of the business in the hands of private equity groups.

When publicly-traded investors in air ambulances found the volatile nature of the industry to be concerning (due to the impact of weather, payer reimbursement, and the cost of equipment), the industry moved toward a private ownership model, which provided stability and a long-term commitment. The reality is, if there were no for-profit motive, we would not see the level of industry innovation and commitment to the highest-quality care.


Learn more – take a deeper look at the issues.