ln ."tpril EMS, [1year-old Christian Bolling was hiking with his parents and sister in 1'v'irginia's Blue Ridge Mountains, near their home in Roanoke. 1|Illi'hile climbing some boulders, he lost his footing and fell down a rocky Ell-foot drop, Fracturing both bones in his lower left leg, his wrist, both sides of his nose and his skull. .r'i rescue squad carried him out of the woods, and a helicopter ew him to a pediatric hospital trauma unit in Roanoke. Most of Christian's care was covered by his parents1 insurance. But one bill stood out hidTrans, The air ambulance company, was not part of the family's health plan network and billed 33:3,111111' for the Still-mile trip from the mountain to the hospital. it was greater than the cost of his twohday hospitalization, scans and cast combined. 1"lilti'henyou1re in that moment, you're only Thinking about the life of your child," says Christian's mother, Cynthia Bolling, an occupational therapist. "1 know I'm being taken advantage of. It's just wrong." The rising number of complaints about surprise medical bills is spurring efforts on Capitol l lill and at the 1ill'l'iitc House to help consumers. {liver and over again, the high cost associated with air ambulance service gives patients the biggest sticker shock the subiect has come up at nearly every Capitol Hill hearing and news conference on surprise medical bills. Yet air ambulance costs are not addressed in any of The proposals introduced or circulating in Congress. liven a congressional decision last year to set up a panel that would study air ambulance billing hasn't gone anywhere. 1"Illi'e're doing a disservice to patients if we protect Them from hospital bills but bankrupt them on the way there," said James Uelfand, senior vice president for health policy for the liRJSi'i Industry Committee, a trade association for large employers. The issue came up again 'Wednesday at a House Energy and {loonnerce subcommittee hearing where Rick Sherlock, president and CED of the Association of Air Medical Services (the industry group for air ambulances), was among eight witnesses. Rep. Ben Hay lsiian, U-NJ'i-L, sharply questioned Sherlock as to why costs for air ambulance services have risen by 31111'1i in his state since lellfi. "l'm trying to get my hands around why this is costing so much and why so many of my constituents are being hit by surprise bills," Luian said. Sherlock explained that reimbursements from i'vledicare and Moiicaid do not cover the cost of providing services. So charges to private patients, he told the legislators, must make up that difference. .r'tir ambulances serve more than 5511,111111 patients a year, according to industry data, and in many rural areas, air ambulances are the only speedy way to get patients to trauma centers and burn units. As more than \"111 rural hospitals have closed around The [1.51. since 211111, the need has increased for air services... The service, Though, comes at a cost According to a recent report from the Government Accountability llfIJ'ffice, twohthirds of the more than 34,1111\" air ambulance transports esami ned were not in The patients' insurance networks. That can leave patients on the hook for the charges that their insurers don't cover, a practice known as balance billing. in 211IT, The {Si-HE! found that the median price charged nationally by air ambulance providers was around $31,411\" for helicopter rides and even higher for other aircraft. The total generally includes the costs for both the transportation and the medical care aboard the aircraft... lE'E_i.'ntl'tia Bolling says her insurance company paid about a third ofChristian's air ambulance bill, and The family settled this week with Med-Trans, agreeing to pay 54,411\" out of pocket Reid Vogel, director of marketing and Communications for Med-Trans, says he can't discuss a particular patient's case because of privacy rules. But, he adds, Med-Trans works with patients to find "equitable solutions" when their bills are not covered by insurance. Since nearly three quarters of flights are for patients insured by low-paying Medicare, Tricare and Medicaid, he says, "providers must shift costs to insured patients." Yet private insurers usually will pay only an amount close to what Medicare reimburses, which is around $6,500. That gives air ambulance companies an incentive to remain out of network, according to a 2017 GAO report. "A representative from a large independent provider noted that being out of network with insurance is advantageous to the provider because a patient receiving a balance bill will ask for a higher payment from the insurance company, which often results in higher payment to the air ambulance provider than having a pre-negotiated payment rate with the insurer," the GAO found in its report