The Issues
Emergency air medical care connects patients to treatment they cannot reach on their own. Protecting that access means addressing three connected challenges.
Distance puts care out of reach. Rural communities face substantial gaps in access to specialized care.
Payment disputes threaten readiness. Aircraft, medical crews, and bases require dependable resources.
Patients need the lifeline to remain available. Payment disagreements should stay between providers and insurers.
A Lifeline in the Air
The National Association of Insurance Commissioners cites an industry estimate of more than 550,000 patients using air ambulance services each year. These flights connect patients with specialized care, including transfers from community hospitals to larger treatment centers.
Air medical transport combines aviation with skilled clinical care. For patients facing long distances or time-sensitive conditions, keeping that capability available matters.
Distance Puts Care Out of Reach
Earlier research estimated that 23% of Americans and 42% of rural residents lacked access to a Level I or II trauma center within 60 minutes by ground ambulance. A 2026 JAMA Network Open study cites those estimates and confirms that substantial access gaps remain.
Air medical services are one important part of the response, connecting patients across distances that ground transport alone may not bridge quickly enough. Rural communities need dependable transport alongside strong local emergency care.
Source: JAMA Network Open, February 2026; prior access estimates.
A Decision Must Lead to Payment
The No Surprises Act protects patients from many surprise out-of-network bills and provides a federal process for resolving eligible payment disputes between providers and health plans.
A study of 2023 air ambulance payment determinations found that provider offers prevailed in 86% of the cases analyzed. EARA’s position is straightforward: resolving a dispute must be followed by timely payment. Winning a determination does not keep an aircraft ready if the awarded payment never arrives.
We support stronger enforcement and a more dependable path to payment for covered care already delivered.
Sources: CMS overview of IDR · JAMA Network Open, March 2025; 2023 data.
Payment Problems Can Become Access Problems
Air medical care depends on people and equipment being ready before an emergency happens. Sustained payment delays can put pressure on staffing, maintenance, aircraft, and bases. Communities already far from specialized care have the most at stake.
Protecting readiness means keeping payment disputes between providers and insurers, while protecting patients’ access to the care their coverage promises.
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Care delivered.
Payment delayed.Providers face sustained uncertainty over payment for covered care.
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Readiness under pressure.
Crews, maintenance, aircraft, and bases depend on reliable resources.
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Patient access at risk.
Reduced capacity can make an already long journey to care harder.
EARA’s advocacy focus: dependable payment and patient protections support a dependable lifeline.
Practical Fixes. Patients First.
EARA supports practical changes that make the No Surprises Act work as intended: binding payment decisions that lead to payment, direct recourse for providers, and patient protections that stay fully in place. We are working with members of Congress from both parties to build support for these solutions.