The Issues
Emergency air medical care is a lifeline for hundreds of thousands of Americans every year. Yet the patients who depend on it face a system where access is uneven and payment is broken. These are the issues we are working to fix.
A Lifeline in the Air
Air ambulances transport more than 550,000 patients across the country every year, more than 1,000 medical flights a day. Nearly half of these are inter-facility transfers, carrying critically ill patients from small community hospitals to the specialized trauma and tertiary care centers that can treat them.
The patients who fly are genuinely in crisis. Between 88% and 90% of people transported by air ambulance are admitted to the hospital as inpatients, compared with roughly half of those transported by ground. Air medical crews respond to cardiac events, strokes and other neurological emergencies, traumatic injuries, and specialized critical care needs such as burns, pediatric, and respiratory failure.
Speed is the reason air transport exists. Clinicians call the first 60 minutes after a serious injury or medical event the Golden Hour, the window in which rapid access to definitive care saves lives. The pilots who fly these missions hold an Airline Transport Pilot certificate, the same FAA standard required of commercial airline pilots.
A Life-or-Death Access Gap
For millions of Americans, the nearest trauma center is simply too far away. 23% of the U.S. population, and 42% of people living in rural areas, cannot reach a trauma center within that critical first hour by ground. For them, air medical transport is not a convenience. It is the difference between life and death.
This gap falls hardest on rural communities, where hospitals are closing and specialized care is concentrated far from home. In many places, air medical transport is the only way to close the distance in time.
A Broken Payment System
When Congress passed the No Surprises Act, it protected patients from surprise medical bills and created a federal arbitration process, called Independent Dispute Resolution, to settle payment disagreements between providers and insurers. Patients were meant to be taken out of the middle.
In practice, the system is not working as intended. In federal arbitration, air ambulance providers win roughly 85% of payment disputes, strong evidence that the payment offers insurers bring to the table are routinely too low.
Some insurers have learned to work the process. They delay resolution, knowing that small, independent air medical providers cannot afford to go unpaid for long. In some cases they make a partial payment and then dispute whether the claim was ever covered at all. These tactics do not just hurt providers. They threaten the survival of the air medical bases that rural communities depend on.
When Providers Are Squeezed, Patients Lose
Air medical transport only works if the bases, aircraft, and crews are there when the call comes. When providers go unpaid or underpaid, bases close, and the access gap grows wider. The patients most at risk are the ones already furthest from care.
Fixing how insurers pay for emergency air transport is not about taking sides between companies. It is about making sure that when every second counts, the lifeline is still there.
What Needs to Change
The rules already exist. They just need to be enforced. Two pieces of federal legislation would close the gaps that leave patients and providers exposed. The LIFELINE Act would make insurers honor the arbitration decisions Congress already created. The PATH Act would ensure patients can assign their claims directly to their providers, so they are never forced to pay upfront and fight their own insurer while sick or recovering.