Introduction Air ambulances are used by approximately 1 in 4000 commercially insured patients annually when distances, medical urgency, and other conditions prohibit ground travel.1 Historically, out-of-network air ambulance organizations could bill commercially insured patients for the balance between their charges and the insurer’s allowed amount, yielding surprise bills averaging approximately $20 000.2-4 Surprise billing for air ambulance services was banned by the federal No Surprises...