Charlie Taylor was loading a four-wheeler into the back of his pickup truck last spring when the heavy rig jumped a ramp, overturned and landed on Taylor’s chest.

The 49-year-old Lyons, N.Y., man broke seven ribs, leaving him barely able to breathe and with no detectable blood pressure, prompting paramedics to call for an air ambulance to whisk him 30 miles to the nearest hospital.

But when Taylor got the bill for that 15-minute flight, it took his breath away — again.

“It’s not that I don’t appreciate the service they gave me,” he said. “But the average citizen can’t afford $8,700 to get to the hospital.”

Eventually, insurance helped foot the bill for Taylor’s flight. But he’s one of the lucky ones.

In a country with dwindling health benefits and rising ranks of uninsured, where the rule is to fly first and ask questions later, some patients are finding emergency air flights may save their lives, but also contribute to medical debt they can’t pay.

“I know it didn’t cost $8,000 to fly from Bradford, Pa., to Erie,” said Leisa Parris, 46, who, like Taylor, responded to msnbc.com’s Dose of Reality health care series.The uninsured woman from Eldred, Pa., awoke in a hospital room six weeks after a severe car crash to find she owed $500,000 in medical bills, including fees for the 97-mile helicopter flight that saved her life.

Costs range from $12,000 to $25,000 per flight

Every year, an estimated 550,000 patients in the United States are flown by medical helicopters and small airplanes for emergencies that include car wrecks, hiking accidents and heart attacks, according to the Association of Air Medical Services. Nearly 1,200 aircraft operate from more than 830 bases across the country, with about half run by hospitals and half run as stand-alone community services.

The average distance of the trips is 52 miles, but the costs vary widely. There's no national requirement to track or report fees, but they can range from less than $12,000 to as much as $25,000 per flight, according to Craig M. Yale, vice president of corporate development for Air Methods Corp., the nation’s largest provider of air medical transport systems.

Air transport is called only after a medical crew on the ground evaluates the condition of the patient, the severity of injuries, the distance to a treatment center and factors such as traffic or rough terrain, Yale said.

Ground ambulances are generally much less expensive, with an average emergency run coming in at $800 to $2,000, depending on the region and other factors, according to J.D. Fuiten, secretary of the American Ambulance Association.

During an emergency, when the aircraft show up, there's usually no mention of money. Providers can't screen patients for ability to pay, and insured patients have to read the fine print of their policies to gauge coverage.

Patients could theoretically refuse air transport out of concern for cost. Fearing high fees, Taylor's wife questioned paramedics about calling the air ambulance, but the seriousness of his condition trumped those worries.

"She said, 'Don't you think that's a little overkill?'" Taylor recalled. "They said, 'Ma'am, your husband has no blood pressure.'"

Bob Wisener, 60, and his wife, Denise, 52, of Republic, Wash., had to pay $8,000 for an emergency flight after Bob had a heart attack in 2006. In 2007, they joined Northwest MedStar's membership program, just in time for a second heart attack. That time, MedStar covered the bills.

To patients who face bills later, the costs can be daunting. Bob and Denise Wisener of Republic, Wash., were charged more than $11,000 for a 120-mile emergency air flight after Bob, 60, a log truck driver, suffered a heart attack in 2006. Insurance paid about $3,000 of the cost, but the Wiseners were stuck with the rest.

"My first thought was, 'How am I going to pay for that?'" recalled Denise Wisener, 52, a massage therapist.

Industry experts defend the high fees for emergency air transport, saying they're a microcosm of a health system where everyone expects immediate, expert emergency care, but patients, insurers and government providers are reluctant to pay for it.

“We’ve got to collect enough money for the service, or the service goes out of business,” said Dr. Kevin Hutton, a San Diego emergency room doctor who founded Golden Hour Data Systems, Inc., a medical billing system for air providers.

Medical helicopters and airplanes are paid only when they transport people, typically a base fee to launch an aircraft and then a fee for every loaded mile it flies. In Charlie Taylor’s case, the Mercy Flight charges included $7,000 for basic fees and then $55 a mile for the 31 miles to the hospital, his bill showed.

“I’m glad my insurance company paid it, but at the same time, I’m a little angry and put off that that’s what they were charged,” said Taylor, an auto service advisor who pays $600 a month for health insurance. “If they’re paying $8,700 for an ambulance for somebody, how long is it going to take for me to pay it off through my premiums?”

High cost of readiness

What’s not apparent from the per-mile fees is the high cost of readiness, said Yale, whose own operators transport about 98,000 patients a year in 43 states.

“You’re paying for the capacity to be able to respond,” said Yale.

Costs include aircraft that can range from $2 million to $6 million, on-board medical equipment that can include $10,000 heart monitors, and the price of round-the-clock staffing with top-tier emergency doctors and nurses, who must be not only highly trained, but also able to operate at a moment's notice under the most difficult circumstances. Jet fuel prices also fluctuate widely.

“We’ve been forced to pay for these services with the few unfortunate people who need it,” said Hutton.

About 40 percent of patients who require emergency air transport have some kind of private health insurance, but about only about 60 percent of insurers pay the full costs, Hutton said. Some insurers pay as little as $300 out of a $17,000 bill, for instance. Others can stall on payment, forcing air transport companies to bill and re-bill.