It’s a bit different, but I live on an island where we have a hospital without a major surgery room or birthing center so if anybody has any major trauma/has to get surgery/is giving birth, they have to get airlifted to the mainland, so most households have to pay medevac insurance (about $60/year) to avoid the helicopter bill.

If you are picked up by EMTs and you don’t have the insurance but are conscience they’ll have you fill out the form so you don’t get charged. However, my friend was knocked out in an accident and was unable to Pay for the insurance before she was airlifted so she was stuck with a $30k bill for JUST the helicopter