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Usually it is direct billed to the requester. It is then up to them to see if any insurance can cover it. For essential emergency service many insurance companies will cover some cost. Other than that usually no coverage. Different levels of equipment and service with air ambulance. Critical care, basic life support, etc. Twin piston to jet, and of course short range helicopter. Respirtory (sp?) specialist if on trach tube, etc. My extended family was looking at transporting my comotose niece west to east coast. High end $35k low end $22k with flexibility in schedule. A couple of organizations also may help to reduce cost - www.aircompassionamerica.org - very nice people. My niece improved at a local rehab center and they were recently able to fly her airline 1st class with an attending nurse back home.
 
Congrats to your niece CVSfly! The Air Medical Company I fly for has a fee for service, a yearly membership, insurance companies, and the government. As for the prices, well that depends on where you are going to and from where. International flights are expensive to say the least.
 
I was lifeflighted on 10-21-07 and the cost for the flight was $10,600. My insurance paid 90%. I am responsible for the other 10%. Without lifeflight being available, I would be dead now. Thanks to Memorial Hermann lifeflight that day in Houston.
 
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