America has almost a thousand medical helicopters that transport patients in urgent situations. The services can be lifesaving, but expensive. 1/
The bills can typically be $30,000 or more, and the charges have gone up quickly -- more than doubled between 2010 and 2014, according to GAO. 2/ bloomberg.com/news/features/…
If patients are uninsured, or if insurers don't cover the full costs that ambulance providers charge, they often balance bill patients. 3/ bloomberg.com/news/features/…
That leads to bills like this, which was sent to the estate of a patient who died following a medical flight. $34,495 for an 18 mile helicopter flight. (After the $4,000+ insurance agreed to pay.) 4/ 
If patients are covered by Medicare or Medicaid — about 56% of medical flights — air ambulance companies can't balance-bill. They have to take payment, which is often below their costs (especially for Medicaid). 5/
How much air ambulance flights should cost in the private market is a fascinating economic question, because patients cannot "shop" and providers can't turn away patients. So how does the "market" determine a fair price? 6/ bloomberg.com/news/features/…
An additional wrinkle: Federal law considers air ambulance operators to be "air carriers" like Delta or JetBlue, meaning states can't regulate their charges. 7/ bloomberg.com/news/features/…
If insurers and air ambulance companies could negotiate in-network contracts, that would protect (insured) patients. One insurer in West Virginia told regulators that Air Methods "refuses to discount its services by more than 3% of its total charge.” 8/ bloomberg.com/news/features/…
Most air ambulances are for-profit and now owned by private equity groups (including KKR, lately seen buying another health care company bloomberg.com/news/articles/… known for surprise emergency medical bills nytimes.com/2017/07/24/ups… )
The air ambulance industry maintains that it has to charge high prices to private insurers because it loses money on Medicaid/Medicare flights. “We need to hold the insurers’ feet to the fire to say we need a reasonable rate,” one exec told me. 9/ bloomberg.com/news/features/…
Important to note that these companies are still profitable, with margins slightly above other health services 10/ bloomberg.com/news/features/…
A lot of patients are getting bills that look like the down payment on a house. "I was angry and I felt like we were being taken advantage of," said the mother of one 3-year-old patient (family is suing company) 11/ bloomberg.com/news/features/…
PS: If you have a story about your experience with air ambulances (or anything else really interesting and health care-related), here's how to reach me: jtozzi2@bloomberg.net (or DM for phone or signal)
