Last month, a hiker on a high-alpine plateau just beneath the summit headwall of the highest peak in Montana made a painful calculation.
David Cifaldi had taken a fall on his way to Granite Peak in the Beartooth Mountains, near the Montana-Wyoming border, and ended up with the sharp end of a trekking pole driven through his torso.
His dilemma was widely reported by news outlets and online commentators: He could sit tight for a helicopter to whisk him away, or he could hike 10 miles back to the trailhead with his gruesome injury. Cifaldi, a 32-year-old nurse from Billings, decided the physical puncture would be preferable over the pain in his pocketbook.
“‘Tis but a flesh wound,” Cifaldi told his friends, according to The Associated Press. He said he didn’t want to be on the hook for a sky-high helicopter rescue bill. “Search and rescue coming to help you is free,” he said. “The flight’s not. That was a factor in me deciding to self-rescue.”
But how high would the cost of a wilderness helicopter rescue actually run — and based on what factors?
The answer is complicated. Search and rescue in Montana is largely a public service, funded by taxpayers and carried out mostly by volunteers. But once a helicopter enters the airspace, the economics can change dramatically. Federal law has given people with health insurance more protection from surprise bills, but the particulars of backcountry rescue — and the particulars of different insurance plans — remain confusing. Even officials acknowledge there’s no simple answer to the question Cifaldi faced on Froze-to-Death Plateau.
How backcountry rescue works
Backcountry recreation is growing across the region and the country. Since search and rescue (SAR) groups are coordinated at the county level, comprehensive data doesn’t exist. But survey data provided by Nannette Gilbertson, executive director of the Montana Sheriffs and Peace Officers Association, shows that Montana search and rescue teams worked more than 13,700 hours on at least 306 missions in 2024. In 2025, SAR teams responded to at least 272 missions, working nearly 12,000 hours.
When a SAR team receives a call about a backcountry rescue, a complex chain of events begins. While some details vary from place to place, three SAR coordinators from across southwest Montana described the process playing out like this:
Officials assess the danger and urgency of the situation, and the resources available. Can a rescue team get there on foot quickly enough to provide useful aid? If so, they will, using the resources they have.
“Our job is to get people out of bad places as quickly and effectively as we can, and then get them to the next level of care,” said Matt Boxmeyer, SAR captain with the Gallatin County Sheriff’s Office and chairman of the Montana Sheriffs and Peace Officers Association Search and Rescue Subcommittee.
In Montana and in most states across the country, search and rescue operations are a public good. In general they’re funded by taxpayer dollars, along with donations and grants in some cases. The people doing the work are overwhelmingly volunteers.
“Search and rescue is never going to send a bill to anybody for anything,” chief deputy with the Stillwater County Sheriff’s Office Ty Williams said. “Just the same concept as the Sheriff’s Office doesn’t charge to respond to an emergency at your house, we’re not going to charge to respond to an emergency in the backcountry.”
If a boots-on-the-ground approach isn’t an option, SAR teams will consider a helicopter — and that’s where cost calculations get tricky, depending on the helicopter teams nearby and the technicality of the rescue. Some are free, public resources. Some are operated by nonprofit companies. And others still are run by private companies with bills totalling tens of thousands of dollars for which the rescuee may or may not be on the hook.
When a helicopter costs money
When someone in the backcountry needs urgent medical care and a transport to a hospital, rescuers call in a private air ambulance when other available resources can’t meet their needs. In those cases, the private company will send a bill to the patient’s insurance company, said Nicci Urbigkit with Guardian Flight Wyoming, a private operator in Cody.
“When most people think about air rescue, they picture the helicopter,” Urbigkit said in an emailed statement. “What they don’t always see is that we’re really delivering a mobile intensive care unit to patients who may be hours away from definitive treatment. Our job is to bring advanced medical care directly to the patient and get them to the right hospital as quickly and safely as possible.”
Urbigkit declined to provide a specific figure for the average cost of a Guardian flight. She said the exact number varies based on the patient’s medical condition, the distance traveled and the level of care required.
“[W]e’re really delivering a mobile intensive care unit to patients who may be hours away from definitive treatment.”
Nicci Urbigkit, Guardian Flight Wyoming
A 2016-2017 analysis by the Brookings Institution found that air ambulance trips cost an average of about $32,000. Loren Adler, a health economist and the study’s author, said those costs have continued to rise in years since. He estimates the average air ambulance flight now comes closer to $50,000.
In a traditional market, Adler said, a consumer can pick and choose what service to utilize ahead of time. Market forces set prices. Companies compete against each other. Fundamentally, the consumer has the power of choice. But for air ambulances — whether in the front- or backcountry — “it’s all post-hoc,” Adler said.
“There’s not really any sort of functioning market for air ambulances in the U.S. right now,” Adler said.
Injured in the backcountry, people in need of rescue don’t get to pick between companies. For years, that meant patients could be hit with enormous out-of-network bills after being transported by an air ambulance.
But federal law has changed that landscape.
What insurance covers
The No Surprises Act, a bipartisan federal bill that went into effect in 2022, overhauled how air ambulance billing works. According to the law, insurers must treat all air ambulances as in-network. Adler said that change means the days of surprising, astronomical bills are over — at least in theory.
Prior to the No Surprises Act, patients were faced with out-of-network charges they had no say in after many emergency medical situations. They might get released from the hospital only to find their insurer would only cover a tiny fraction of their bill. “Air ambulances were one of the most extreme versions of this just because you are almost always dealing with a five-figure bill,” Adler said.
But the No Surprises Act doesn’t mean air ambulances are free to use — all of a person’s costs depend on their insurance plan. If a patient has a high deductible and cost-sharing, they can still be on the hook for a lot of cash. But Adler said they might incur those fees from a hospital visit anyway. “You can still get stuck with a high bill, but at least it’s being treated as a traditional in-network medical service rather than the old days where you could often get these $20,000 or $30,000 balance bills,” he said.
In some backcountry rescue scenarios, a patient may still need to use a ground ambulance, a service not covered by the No Surprises Act. Still, Adler said patients with commercial insurance are far better protected today than they were before the law took effect. “It’s not nothing,” he said about the bills patients could be left with. “But I think it’s going to be much more something someone’s willing to pay.”
But there’s another important caveat to the overall picture of backcountry rescue: Not every helicopter rescue is an air ambulance.
The choppers that don’t send a bill
Montana SAR teams have access to a variety of public and nonprofit helicopters that might get called in for a rescue — and wouldn’t charge a patient a dime.
The Air Force and National Guard both have helicopter units that can respond to emergencies. These are federal resources, funded by taxpayer dollars and free of charge to injured backcountry recreators. These federal choppers can come with highly-trained medical personnel and rope-hoist systems for technical backcountry rescues.
However, those federal resources aren’t always available for a rescue or fast enough to reach far-away patients. A federal chopper might need to take off from Great Falls to access a stranded climber near the Wyoming border. That can take hours.
Federal policy also dictates that SAR teams can only call in federal resources when private companies aren’t available or are inadequate. “Basically the federal government does not want to take work away from private companies,” Williams said.
Search and rescue responders conduct subjective and urgent calculus when responding to backcountry emergencies: “Am I putting the patient at greater risk by not getting them the fastest resources?” Park County Sheriff Tad Dykstra said.
Private choppers have limitations, too: They might not be able to reach certain elevations, or might lack the equipment or personnel necessary for highly technical rescues where terrain limits landing and rescue options. In these cases, responders can go straight to federal resources when necessary.
Finally, some counties, and even a nonprofit in the state, have resources that come at no cost to the person being rescued, making a stranded person’s location and the availability of local resources a significant factor in their luck of the draw. Gallatin County, for example, has a renowned high-angle rescue team. Yellowstone County has access to a helicopter, too. Two Bear Air, a nonprofit based in Kalispell, never charges either rescuers or counties for their services.
Ultimately, SAR coordinators said that figuring out exactly which helicopter gets called in is a complex process that varies based on the situation: How severe is the emergency? Could you freeze, drown or bleed out? Is there somewhere to land, or will they need to hoist the person into the air? Will the chopper need to treat the person in-air? Will they fly the patient to the hospital or to an ambulance waiting on the ground near the trailhead? And finally, who is available to get there before things get worse?
Extracting a person from a dangerous situation differs from the medical treatment they might need. If you’re stuck on a cliff or too dehydrated to continue on, a rescue helicopter may simply remove you from the backcountry. In those situations, a private air ambulance is unlikely, SAR responders said. But if you have a broken femur or a traumatic head injury deep in the wilderness, that could be a different story.
“We look at each situation differently, and we’re not gonna call an air ambulance for someone that doesn’t need it,” Boxmeyer said.
While this decision-making process is playing out, those in need of a rescue are often in the dark, without service or any say in who ultimately comes to transport them out of the backcountry. Rescuees, like Cifaldi, can always decline a helicopter, or even a ground ambulance, if they’re capable of weighing the pros and cons.
Don’t hesitate to call
Several SAR officials noted that Cifaldi was a medical professional. In general, rescue officials don’t want recreators in need to forgo professional help.
“With the nature of our mountains, it can easily turn into a body recovery if you’re not prepared to be in the backcountry,” Dykstra said. “I would much rather have people call and have our county pay for it than have someone expire in the backcountry just because they didn’t think they could afford it.”
As recreation grows — along with emergencies in the backcountry — Boxmeyer said whether and how to charge for SAR services has come up many times in policy discussions. But the conversation never seems to go anywhere.
“We look at each situation differently, and we’re not gonna call an air ambulance for someone that doesn’t need it.”
Matt Boxmeyer, SAR captain with the Gallatin County Sheriff’s Office
States like Colorado, New Hampshire and Utah offer buy-in programs that support search and rescue teams to alleviate pressures on local tax bases. A smattering of other states, including Idaho, Utah, Oregon and Maine, have caveats to their policies that allow SAR teams to charge rescuees in cases of negligence or entering closed areas.
Boxmeyer said charging for SAR services in Montana has been a non-starter. At the heart of the decision-making is a core idea: The public shouldn’t be weighing their own safety against the cost of a rescue. In practice, of course — as Cifaldi’s case demonstrates — the public hasn’t fully grasped that sentiment.
SAR responders across the region stressed that recreators should be prepared for emergencies and carry a way to communicate. For added peace of mind, satellite companies like Garmin and Zoleo offer rescue insurance, and so do networks of air ambulances like Life Flight and other groups like the American Alpine Club — though SAR coordinators cautioned they couldn’t attest to how effective or comprehensive those plans are on the ground.
Boxmeyer said in practice, fears about big bills for backcountry rescue are overblown. He said Gallatin County responds to lots of rescues on and near Granite Peak, where Cifaldi hiked 10 miles with a pole through his torso to avoid a helicopter bill.
“I’ve had lots of friends call and ask me about that guy who hiked out of the Beartooths with a pole stuck through him,” Boxmeyer said. “He wouldn’t have received a bill from us.”
