Every American deserves access to life-saving health care services, regardless of where they live, what kind of health coverage they have, or their ability to pay. In the event of a trauma or other serious injury or illness, millions of people living in rural areas must rely on air transport by helicopter for timely access to emergency care because they simply cannot receive it in time via ground.

In fact, nearly one-third of the U.S. population cannot reach an adequate trauma center within one hour without air transport. This one-hour window is absolutely critical. Known as the “Golden Hour,” the first 60 minutes after a serious illness, injury or trauma, such as a stroke or severe burn, are the window in which the difference is often made between life and death, and preserving quality of life. For those of us who have been in those helicopters treating critical patients, the phrase “time is tissue” is a phrase to live by.


But today, communities are at risk of losing access to this vital service because of a fundamentally flawed insurance reimbursement system, in which providers of air medical services are being drastically under-reimbursed by Medicare and Medicaid and by certain private providers.

Provision of high-quality air medical services is a high-cost but vital operation. Lives depend on it. We provide a high level of medical care to the patients we service, and our industry is meticulously regulated—we comply with a full spectrum of both health care and aviation regulatory regimes. Our bases and top-notch crews must be ready to respond on a 24-7-365 basis. Importantly, we will only respond when a physician or first responder requests us and deploy without regard to a patient’s ability to pay. And while the costs of providing care are only rising, we face consistent reductions in reimbursement payments for our services.

At the root of the problem is the fact that air medical transport providers are egregiously under-reimbursed for more than 70% of the transports we carry out. This is because most of our transports are for patients with either Medicare, Medicaid, have another form of government insurance, or no insurance at all. Currently, the average Medicare reimbursement for emergency air medical services covers only about 50 percent of our transport cost, whereas Medicaid in many states reimburses at even lower rates.

The dramatic shortfalls in reimbursement, combined with a continued decline in reimbursement by many private insurers, has set in motion a dangerous trend: bases are being forced to close, especially in rural areas. I have witnessed this first-hand.

Earlier this month, Air Evac Lifeteam was forced to announce the closing of our base in Martins Ferry, Ohio. Ohio has the highest percentage of Medicaid transport volume in Air Evac Lifeteam’s service area, but Medicaid in Ohio reimburses less than $2,000 per transport, far below what it actually costs to carry out a transport by air medical helicopter.

Ohio is just one example of the chasm between air medical reimbursement and true cost of service. Due to poor reimbursement, we also closed a base in Alabama, where Medicaid reimburses less than $700 per transport. In Pennsylvania, Medicaid reimburses only $200 per transport. In Utah, Medicaid reimburses $206. To put that into perspective, the average cost of fuel alone for one transport is $450.

It does not have to be this way. One opportunity is immediate: there are currently two pieces of federal legislation, S. 1149 and H.R. 822, which would protect access to air medical service by resolving the Medicare reimbursement shortfall and study the matter in greater depth. We must work to pass these bills, and ensure policymakers and regulators understand that if we do not, communities will feel the impact. Second, individual states must examine their current Medicaid reimbursement structure and ensure that Medicaid rates reflect the true costs of this vital service.

Separately, there is a desperate need for insurers and air medical transport providers to engage in earnest and solutions-oriented reimbursement conversations. Air Evac Lifeteam is willing to come to the negotiating table with insurers and reach in-network agreements that are fair and that free patients from being stuck in the middle of balance-billing procedures that we desperately want to get rid of. Solutions are possible. A recent study conducted in Montana, for example, showed that for an increase of only $1.70 per month in insurance premiums, air medical transportation can be reimbursed in full, meaning providers wouldn’t be forced to balance-bill, and patients would see relief.

Policymakers and stakeholders must come together quickly to act on behalf of patients and communities who rely on air medical services.

Myers is the President of Air Evac Lifeteam, the largest independently-owned and operated membership-supported air medical provider in the U.S. with more than 125 bases across 15 states. Myers has over 38 years of experience in the emergency air medical industry. He was previously the Director of the University of Florida’s Medical Center transport system, a former flight nurse, and a commissioned officer in the Army’s first trauma center, and serves on the Air Medical Operators Association Board of Directions.

The views expressed by authors are their own and not the views of The Hill.