In many recent cases, patients are not just surprised by the amount of their medical bills; they’re also shocked by when they receive them. Jessica Robbins from Chicago, for example, was billed $3,300 for a breast MRI two years after the procedure. She had received prior authorization from her insurer at the time, Blue Cross and Blue Shield of Illinois. But due to clinic acquisitions and insurance changes, Robbins was left entangled in a bureaucratic loop with no clear resolution. The provider, now Endeavor Health, stated that they were working to resolve the issue but for patients like Robbins, that’s little comfort after months of back-and-forth.
This lack of transparency and delayed communication makes navigating healthcare costs extremely difficult, even for the most informed patients.
Why the Air Ambulance Industry Is Especially Vulnerable
Air ambulance services are notorious for surprise billing. Despite the No Surprises Act offering some relief in emergency cases, the protections are limited. Many patients flown in emergency conditions receive bills months later for services they never had a chance to approve or understand. In some cases, the air ambulance provider is not contracted with the patient’s insurer, and the resulting out-of-network charge can be staggering.
Moreover, unlike standard healthcare services, air ambulance costs are difficult to estimate in advance, making “good-faith” estimates nearly impossible. If a patient uses insurance, they’re still not fully protected from surprise air transport charges due to the incomplete implementation of certain provisions of the law.
The Gap Between Expectation and Reality
Patients like Mary Ann Bonita, who sought a chest x-ray urgently, or Michelle Rodio, who was stunned by a $2,700 bill for a nasal swab, all echo the same concern: Despite asking questions and doing their due diligence, they were still hit with bills they couldn’t predict or contest effectively.
Zack Cooper of Yale University noted that while the No Surprises Act addressed one form of abuse — out-of-network charges in emergencies — it left many others untouched. And CMS has acknowledged receiving tens of thousands of complaints that point to areas not currently covered.
What Needs to Change
For true financial transparency, especially in critical services like air ambulance transport, the law must evolve. A comprehensive approach that mandates clear estimates, closes loopholes, and includes better enforcement is the only way to truly eliminate surprise medical billing, for all patients, in all scenarios.
