Air Ambulance Prices Rose Substantially for Commercially Insured

The price for air ambulance transports has risen substantially over the past couple of years, especially for commercially insured patients, according to a recent FAIR Health analysis.

The analysis leveraged FAIR Health’s private healthcare claims data repository to examine both longitudinal and non-longitudinal claim lines from 2016 to 2020. Researchers then paired the data with Medicare claims lines from the same period.

They found that average chairs, estimated allowed amounts, and Medicare reimbursements for both fix-wing air ambulance rides and rotary-wing air ambulance trips all increased.

The average charges associated with fixed-wing air ambulance transports rose by 27.6 percent, from $19,210 in 2017 to $24,507 in 2020, while the average estimated allowed amounts rose by 76.4 percent, from $8,855 to $15,624, and the average Medicare reimbursements rose by 4.7 percent, from $3,071 to $3,216.

For rotary-wing air ambulance transports, average charges rose by 22.2 percent, from $24,924 in 2017 to $30,446 in 2020, average estimated allowed amounts rose by 60.8 percent, from $11,608 to $18,668, and average Medicare reimbursements rose by 4.7 percent, from $3,570 to $3,739.

And while prices soared, utilization also increased. Air ambulance claim lines increased by 30 percent as a percentage of all ambulance (ground and air) claims lines from 2016 through 2020, the analysis found.

The transports were predominantly for older patients (55.4 percent of claim lines for fixed-wing transport and 63.6 percent of claim lines for rotary-wing transport) and for patients with heart attacks, digestive system issues, cerebrovascular issues and diseases, and head or body injuries.

Patients were also significantly more likely to be admitted as inpatients to a hospital when transported by air ambulance for an emergency compared to patients transported by ground ambulance.

The analysis comes on the heels of new regulations around air ambulance bills. Passed at the end of last year, the No Surprises Act will prohibit surprise medical billing in most situations, including balance billing from out-of-network air ambulance service providers. The Act also authorizes states to enforce some provisions of the No Surprises Act with respect to air ambulance providers, FAIR Health noted.

A recent regulation that will implement the No Surprises Act at the start of next year specifically addressed air ambulance provisions. The regulation released in early September details the data air ambulance providers must submit to HHS per the No Surprises Act. The data includes transportation and medical costs, data on air ambulance bases and aircraft, the number and nature of air ambulance transports, payor data, and data on claims denials. 

HHS, along with the Department of Transportation, will generate a publicly available report on air ambulance services to “help shed light on the drivers of the high costs of these services.”

“The air ambulance industry is a highly consolidated market that often leads to surprise bills for patients,” HHS Secretary Xavier Becerra, said at the time. “These rules would allow HHS to collect data to analyze the industry’s market trends and costs and provide critical information that will address exorbitant air ambulance expenses.”

Despite the rising cost of air ambulance transports, few studies have analyzed air ambulance utilization. But with the high prevalence of surprise bills stemming from the transport service, more information is needed to inform policy.

“Air ambulance services have been the subject of substantial policy focus,” Robin Gelburd, FAIR Health president, said in a press release. “We hope that this study of air ambulance transport proves productive to policy makers, researchers, payors, providers and consumers seeking to better understand this corner of the healthcare system.”