To determine the reimbursement status of a helicopter aeromedical program and its sponsoring hospital, the financial records of all patients transported by a university hospital-based helicopter aeromedical service during a one-year period of time were examined. The flight program was able to collect only 43% of patient charges, recouping only 24% of its operating costs. The hospital collected 57% of its total charges to patients transported by the helicopter aeromedical program. Reimbursers paying on a per-diem basis comprised 36% of the payors and had collection rates of 50% and 10% for the hospital and flight program, respectively. Cost-based insurers constituted 20% of the payors, provided 44% of program revenue, and had collection rates of 92% for the hospital and the flight program. If cost-based payors had reimbursed on rates similar to the per-diem payors, the hospital would have recovered only 49% of its charges and the flight program, would have recovered only 26% of its charges, recouping only 15% of its operating costs. In conclusion, reimbursement for helicopter aeromedical services and for the care provided in aeromedically transferred patients is poor. Sponsoring institutions are consequently subjected to significant financial stress that possibly challenges the fiscal viability of some programs.