OKLAHOMA CITY - Chances are, it will never happen to you.
Most people never find themselves in the kind of emergency where they need a helicopter to fly them to a hospital for treatment.
A medical helicopter crash in Seminole County Jan. 2 raised questions for some about the necessity and the safety of air ambulance travel.
It is an industry where shaving an hour or two hours off transport time is enough to save a life.
Time is critical when it comes to preserving heart muscle or brain tissue.
That is why the use of air ambulances is on the rise.
According to the NTSB, 400,000 patients and transplant organs are moved by chopper each year.
The industry grew by more than 50 percent in the five-year period between 2003 and 2008.
There are three air ambulance services operating in Oklahoma right now: Air Methods, which operates as Mediflight in the Oklahoma City area and Life Flight in the Tulsa area, Eagle Med and Air Evac LifeTeam.
All three companies operate 24 hours a day, seven days a week, with a pilot and medical staff at the ready at all times.
There are 19 helicopter bases spread out across Oklahoma, mostly in rural locations.
"We encourage the EMS community to call the closest most appropriate provider aircraft to the accident scene," Susan Cook said, Air Methods Regional Business Director.
Air ambulance services do not self-dispatch.
Experts said that provides a layer of protection against the temptation for air ambulance companies to troll for service calls.
Medical helicopters only respond to a trauma scene when called by a first responder.
"We are only utilized for the most critically injured or ill patients," Cook said. "So if you are flown, chances are you needed to be flown or we wouldn't have been utilized."
Attorney Noble McIntyre cautions, brace yourself for the bill.
Air ambulance services charge a base rate just for take-off, between $10,000 and $15,000.
In addition, they charge a per mile rate, between $100 and $150 per mile.
"It's an incredibly expensive way to get to the hospital; I think the average bill runs between $12,000 and $25,000," McIntyre said.
A recent shift in the business model for most companies in the industry means medical emergency air travel is getting more and more expensive.
Most companies have shifted from a hospital-subsidized business model, to a community-based model.
Area hospitals no longer cover a portion of the cost to fly, as they once did.
Air ambulance companies defend their astronomical bills saying the patient pays for readiness.
"The largest part of our cost is maintaining readiness because we are a 24/7, 365-day a year operation," Cook said. "Our crews are constantly ready to go to a call."
Another reason air transport is so expensive is because patients are paying for their bill, plus a portion of the cost for patients who have used the service but who are unable to pay.
"If they're going to offer the service, they're going to offer the service for everybody, " McIntyre said. "When they get the call to Burns Flat, Oklahoma to pick up 'Joe' who was in a terrible accident, they don't arrive and say, 'Joe, we have some forms for you to fill out and before we put you on the helicopter. We need to see your insurance card and we need three forms of payment.' They don't do that."
According to the CEO of Air Evac LifeTeam, Seth Myers, his company collects well under 50 cents on the dollar that they charge.
"There are many people that we go out, pick up and fly in and we never receive a penny for that flight," Myers said. "It's a very common issue in the medical field."
Unfortunately the consumer doesn't have many options either.
A patient is legally able to refuse an air ambulance, just as a patient has the right to refuse ground travel to the hospital.
However, a refusal is unlikely since most air ambulance transports are people who are critically injured or unconscious and in no position to shop around for the best price.
About half of all air transports involve flying patients from a rural hospital to a better-equipped metro hospital.
In those cases, rural patients might consider requesting the company for which they have purchased a membership.
All three air ambulance companies offer a membership program which covers any balance after insurance.