What to Know
Air ambulance service prices have more than doubled since 2010
A typical air ambulance trip can cost more than $40,000
Most health insurance policies do not cover air ambulances as "in network" providers
Your kids are sick. Their lives are on the line. The doctor orders an air ambulance.
Do you stop to think about the cost?
That's the dilemma two Bay Area families faced. They chose the fastest route to the hospital: by air. But later, both got surprise bills that could put them deep into debt.
April Harais' son Connor had a severe allergic reaction at their home in Fairfield. Doctors at their hometown emergency room ordered an air ambulance to take Connor to the children's hospital in Oakland.
"I was terrified," Harais said. "I didn't know what was going to happen."
Hundreds of miles up the California coast, in Arcata, David Rodriguez's newborn twin sons faced a life-threatening blood condition. Doctors put the boys on an air ambulance flight to the Stanford Children's Hospital in Palo Alto, for placement in a neo-natal intensive care unit, or NICU.
"Don't mess around," Rodriguez said, recalling the doctors' actions. "Get these guys into a NICU right away."
Both families have health insurance. But their insurance providers denied their claims: more than $50,000 for Harais, and over $140,000 for Rodriguez. In both cases, the insurance companies told the families the air ambulances were "not medically necessary."
That decision frustrated Harais, a mother of three. "Why did they think they're the ones equipped to make that judgment call?" she said.
After NBC Bay Area got involved, each insurance company paid the air ambulance bills in full. But we still wanted to know why the prices were so high.
Lisa Berry Blackstock, a professional patient advocate, helps families fight medical bills. She says air ambulances weren't always that expensive.
"I roughly calculated the price to transport a patient was $250 a mile," Blackstock said. "I happen to think that's beyond price gouging."
A 2017 study by the Government Accountability Office, which provides nonpartisan data to Congress, shows the median price for air ambulance transport more than doubled -- from $15,000 in 2010 to $40,000 in 2016.
Don Wharton, director of Business Strategy for REACH Air Medical, says many factors contribute to the rising costs of air ambulance transport.
"It is [a] costly, very cost-intensive industry," he said.
Wharton blames low payments from Medicare, Medicaid, and Medi-Cal for the increase. Those government-funded insurance policies pay a maximum of about $6,500 per flight. Air ambulance providers say that amount doesn't cover the costs, so to make up the difference, they must charge everyone else more.
"It comes down to reimbursement: actual reimbursement per patient," Wharton said. "What we have found is there have been no adjustments on Medicare."
We asked Wharton whether it's fair to charge patients with private insurance more, to cover the costs of Medicare and Medi-Cal shortfalls.
"I think it's very fair that we keep these services available to the 80 million rural Americans that we can provide this service for," he said.
Something else has been happening with the industry. The GAO report notes several recent mergers, acquisitions, and private equity firms buying up air ambulance services -- limiting competition. Today, three private operators control 73 percent of the nation's air ambulance helicopters. This, while prices keep climbing.
Families like yours face another issue: insurance. Nearly all air ambulance providers are "out of network" for virtually all health insurance policies. Wharton blamed insurance companies for the gap.
"The large insurance companies seem to be unwilling to negotiate, where we have favorable terms," Wharton said. "We can really be in-network."
The insurance industry told us the opposite and said air ambulance providers won't negotiate. In a statement, UnitedHealthcare told NBC Bay Area:
"...many, especially large national air ambulance providers, have refused to participate in our network."
Wharton stressed that most air ambulance providers offer a "membership" plan, which families can purchase to cover the costs of an air ambulance transport. While not considered insurance, these memberships come with the promise that any use of an air ambulance by a member patient will be completely covered, with no further out-of-pocket cost.
He also said anyone who receives a large air ambulance bill should immediately contact the air ambulance provider. Wharton said most air ambulance companies want to work with patients on a payment plan, regardless of income or ability to pay in full.
Rodriguez is happy his family's $140,000 bill was finally covered. But he questions why it had to be so high in the first place.
"There's got to be a better way they can make use of their equipment, without having to overcharge literally everyone that they fly," he said.
Congress is slowly taking action, with the formation of a new air ambulance advisory committee in 2019. At the state level, California's Legislature passed a measure that would have required insurance companies to cover most air ambulance costs. The bill was vetoed by outgoing Gov. Jerry Brown. The authors of last year's bill told NBC Bay Area they have no plans to reintroduce it in the current legislative session.