Part of the problem - at least in my area - is that the helicopter is often called when it really isn't needed and a regular ambulance would be fine. I was told this by one of the crew members of the medflight. Of course, they have no choice but to get in the air when the call comes in and when the call comes they have to charge their fee. Since many insurers do not cover it, the medflight often gets stiffed on the bill and they turn it over to a collection agency to get whatever they can. This is another reason why they charge so much - hoping to make up for lost income by essentially making those who are covered pay for those who are not or cannot pay.