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Air ambulance costs soar despite limited use in workers compensation - Business Insurance Skip to content Register for free Search Search Log In Risk Management Cyber Risks Pricing Trends Mergers & Acquisitions Technology Sponsored Content WSIA RISKWORLD Workers Comp & Safety Workers Comp Cost Control Pain Management Workplace Safety International EMEA Asia-Pacific Latin America People Events BI Intelligence Top 100 Agents & Brokers Best Places to Work 2025 Lists Directories Insurance Pricing BI Stock Index Magazine Current Issue Past Issues Subscribe Women to Watch ALL INsurance Resources Risk Perspectives Sponsored Content Webinars White Papers Risk Management Cyber Risks Pricing Trends Mergers & Acquisitions Technology Sponsored Content WSIA RISKWORLD Workers Comp & Safety Workers Comp Cost Control Pain Management Workplace Safety International EMEA Asia-Pacific Latin America People Events BI Intelligence Top 100 Agents & Brokers Best Places to Work 2025 Lists Directories Insurance Pricing BI Stock Index Magazine Current Issue Past Issues Subscribe Women to Watch ALL INsurance Resources Risk Perspectives Sponsored Content Webinars White Papers Risk Management Cyber Risks Pricing Trends Mergers & Acquisitions Technology Sponsored Content WSIA RISKWORLD Workers Comp & Safety Workers Comp Cost Control Pain Management Workplace Safety International EMEA Asia-Pacific Latin America People Events BI Intelligence Top 100 Agents & Brokers Best Places to Work 2025 Lists Directories Insurance Pricing BI Stock Index Magazine Current Issue Past Issues Subscribe Women to Watch ALL INsurance Resources Risk Perspectives Sponsored Content Webinars White Papers Risk Management Cyber Risks Pricing Trends Mergers & Acquisitions Technology Sponsored Content WSIA RISKWORLD Workers Comp & Safety Workers Comp Cost Control Pain Management Workplace Safety International EMEA Asia-Pacific Latin America People Events BI Intelligence Top 100 Agents & Brokers Best Places to Work 2025 Lists Directories Insurance Pricing BI Stock Index Magazine Current Issue Past Issues Subscribe Women to Watch ALL INsurance Resources Risk Perspectives Sponsored Content Webinars White Papers Air ambulance costs soar despite limited use in workers compensation by Louise Esola Workers Comp Coverage , Workplace Safety Apr 14, 2026 The use of air ambulance services in workers compensation claims remains relatively rare but continues to drive significant costs, with payments rising sharply over the past decade, according to a report released Monday by the Workers Compensation Research Institute. Air ambulances play a critical role in transporting severely injured workers, particularly in emergencies where rapid access to trauma care is essential. However, policymakers and payers are increasingly scrutinizing their cost, billing practices and regulatory oversight. The report found that air ambulance utilization is heavily concentrated in rural areas, where access to hospitals and trauma centers is more limited. Among injured workers with more than seven days of lost time, about 1 in 100 in rural areas required air transport, compared with a much smaller share in urban settings. Usage rates were highest in very rural areas, where roughly 1 in 60 workers relied on air ambulance services. Use has remained relatively stable over time: between 1% and 1.2% of rural lost-time claims involved air ambulance transport annually since 2015. Utilization varies widely by state, reflecting differences in geography and access to care. Texas recorded the highest rate, with about 3.5% of rural injured workers using air ambulance services — more than four times the rate seen in a typical state. Southern and Western states generally showed higher use, likely due to longer travel distances and fewer ground transport options. While infrequent, air ambulance services are a major cost driver. Average payments have increased more than 60% from 2013 to 2024, reaching over $25,000 per transport by 2022, according to the report. Costs also differ significantly by jurisdiction. In the 2022-2024 period, average payments ranged from about $10,000 in Texas to more than $50,000 in California, with a typical state averaging around $30,000 per transport. The variation is driven in part by regulatory differences. Some states apply medical fee schedules to ambulance services, while others face legal limits on regulating air carriers under the federal Airline Deregulation Act. This has led to ongoing disputes over reimbursement and whether charges must be paid in full or meet a “fair and reasonable” standard. Despite their high cost, air ambulances remain essential in severe injury cases, particularly involving trauma such as motor vehicle accidents and burns, which have the highest rates of use. 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