Democratic Rep. Cindy Axne sent a letter to House leaders this month, urging them to address surprise medical billing for rural residents in upcoming legislation, specifically asking for protections from the cost of emergency air ambulance trips. 

Medical emergencies can be especially difficult in rural areas, where traditional ambulances have slow response times. On average, air ambulances travel about 50 miles to get patients to the care that they need, but can cost between $12,000 and $25,000, according to the National Association of Insurance Commissioners (NAIC). 

In her letter to House leaders and relevant committees, Axne shared stories from her constituents who have required air ambulance services but then are billed exorbitant rates because of out-of-network costs. 

“Often these are serious medical emergencies that render someone unable to make informed medical decisions, and an air ambulance is the only emergency service fast enough to reach them,” Axne’s office wrote in a statement

The letter reached House leaders Nancy Pelosi, Majority Leader Steny Hoyer, and the Chairs and Ranking Members of the House Committees on Energy and Commerce, Ways and Means, and Education and Labor. as they complete a comprehensive surprise billing package this year.

The use of air ambulance services in the U.S has grown in recent years. From 2002 to 2008 the number of air ambulances has more than doubled. And more than 550,000 patients use air ambulances in the U.S annually according to NAIC.

The increase in use, according to NAIC, can be attributed to an aging population and the shrinking number of emergency departments in existing hospitals. The incredibly high cost of air ambulances is due to expensive maintenance and keeping trained personnel staffed around the clock.

“A traditional ambulance, which may have to travel 50 miles or more, cannot provide timely response in our rural areas. For my constituents needing air ambulance transport, they do not have a choice over which air ambulance will be dispatched – this is a life-or-death medical emergency,” wrote Axne in the letter. “As Congress works to find solutions to surprise billing, I urge you to make sure that our rural constituents’ needs are included by addressing the high cost of out-of-network air ambulances.”