Montana nurse impaled himself, then hiked down a mountain for 10 miles in part to dodge a $30K+ helicopter bill — what it says about US healthcare

This incident happened below the summit of Granite Peak, Montana’s tallest mountain. Loose rock shifted under Cifaldi, 32, and he came down on one of his own poles. He’s a nurse, so he checked himself out to see how serious of an injury it was.

“’Tis but a flesh wound,” he told his two hiking partners, according to The Associated Press.

Cifaldi didn’t think the injury would kill him, and a helicopter rescue could have cost tens of thousands of dollars. He isn’t unusual for running that math. KFF, a nonprofit health policy research organization, puts the share of U.S. adults who have delayed or skipped needed care over the past 12 months, on cost grounds, at 36%.

What happened on the mountain

The county heard from the group at 9:44 a.m., minutes after the fall, over a Garmin inReach satellite messenger. The message was that they were coming out on their own. Ty Williams, who commands Stillwater County Search and Rescue, kept his team where it was. ”He didn’t want our help,” Williams told the AP, and nobody else on the mountain was in danger.

A vehicle was waiting at the trailhead later that afternoon.

The nearest clinic couldn’t handle the wound and sent him on to Billings — to St. Vincent Regional Hospital, where Cifaldi is on staff. Doctors took the pole out there. Total time with steel through his torso: eight to nine hours.

What a helicopter ride actually costs

The number Cifaldi was avoiding is the most-cited figure in this fight. The Government Accountability Office, the investigative arm of Congress, went through claims for privately insured patients and put the median 2017 charge for a helicopter transport at about $36,400. Airplane transports came in at $40,600.

Those charges have little to do with what it costs to fly. Federal health officials at HHS, citing an analysis of 2016 claims, put the median helicopter charge at $238 per loaded mile. Medicare paid $33 for that same mile.

Where the No Surprises Act stops working

Congress went after these bills with the No Surprises Act, effective January 2022. Where a plan covers air ambulance service, the Labor Department says your share is capped at what you’d have paid in network, whatever the operator’s status. Two things void that. A plan that excludes air transport, and a ride that happens on the ground. Either one puts the uncovered amount back on the patient.

The bigger gap is “medical necessity.” In the fall of 2022, Sara England’s 3-month-old son Amari was flown 86 miles from a hospital in Salinas, California, to UCSF Medical Center with a respiratory infection, two months after open-heart surgery. Cigna’s denial letter said his records didn’t establish that a ground ambulance would have compromised his care. The bill came to $97,599, KFF Health News reported. The family’s final appeal was denied in October 2024.

Cigna did not respond to questions about the denial or how it applies medical-necessity criteria to transport ordered by a treating physician, by the time of publication.