I keep seeing HAA operators selling insurance coverage for helicopter transport. How is this still a thing after the 'No Surprises Act' was signed in? 

From an outside perspective this seems like a predatory business model that provides only the illusion of a benefit. As a patient, you don't decide which operator arrives on scene. Also, you may be traveling and be in a region where that operator has no bases. Plus, now that health insurance companies and the medical provider are obligated to settle the balance directly with each other, how is there any benefit to paying PHI, Metro, etc for coverage?

I'm not in the HAA sector, so maybe I'm missing something? Anybody involved with this care to explain?

Have a presence in. They also honor each other's coverage.

with the obvious, the untrue and in no way answers the question. way to go weird guy® you the man.

Directly from the PHI air medical policy terms:

"Please note that a PHI aircraft may not be available at the time a flight request is made due to inclement weather, the PHI aircraft is already in service at the time of the request, the PHI aircraft is undergoing maintenance or repairs, weight limitations of the PHI aircraft, or other reasons that make the PHI aircraft unavailable to respond to a request. Further, if medical or dispatch personnel call another air ambulance provider to respond to your event, your PHI Cares membership will not cover the medical transport provided by another air medical transport provider."

"If another provider transports a Survival Flight member, membership status is not recognized by other transportation providers and resulting fees are NOT covered by Survival Flight."

"Neither the Providers nor AMCN is an insurance company. Membership is not an insurance policy and cannot be considered as a secondary insurance coverage or a supplement to any insurance coverage. Neither the Providers nor AMCN will be responsible for payment for services provided by another ambulance service"

You mentioned Metro in your post is why I'd like to address them only,

Metro does not participate in any kind of insurance program. Their business model

has no stand alone programs and are normally associated with hospital based programs. Metro is NOT involved in the billing of patients. 

The membership keeps you from being billed for what your insurance doesn't cover. Does no surprises mean you won't ever get a bill for fees insurance doesn't cover? No. I would not exactly call giving your local EMS company 70 bucks not to bill you if they fly you "predatory". It's amusing you pretend to think the pilots would know about any of this so they could answer your "questions".

Predatory: Living or characterized by the exploitation of others for personal gain.

Scamming an entire community into paying for fake insurance that implies they are covered when any medical helicopter shows up... yah, I'd say that fits the definition. 

you wouldn't happen to be the op that's just asking questions. lol. thought so bro

Your bro, sis. Lol, lol. Lol.

read English very well, do you?

because not only is he the weird guy®, he's also the stupid guy™ lol

Wise up, or at least try.