A local teenager has just been charged $25000 for rescue from Mt Washington. The State troopers who organize MR determined that he brought it on himself even though well equipped and trained (Eagle Scout) Therefore not an "Accident". High cost because the regular chopper was not available and they had to bring one in from the next state (Maine). More often (varies from state to state) the charge for " Irresponsible" behavior in Oregon and Washington (which have really high mountains) is usually a "nominal" $500. I think Helicopter extraction is usually regarded as Medivac, and so charged as Ambulance service would be, hopefully on your medical insurance. It makes sense to take out insurance as the situation in the US is getting "worse" year by year. I am seriously considering insurance for this year. If you're visiting the US for climbing or hiking, or the Alps, make sure you have adequate extraction insurance and medical insurance reciprocal arrangements with NHS almost certainly won't include repatriation.