Let’s Take The Myth Out Of Medicare Ambulance Transport…..

written by Alicia Sullivan, AirCare Ambulance, and edited by Kathe Kline

Through the years we have been programmed to call 911 when faced with using ambulance transport. The ambulance then arrives on the scene with Sirens, Fire, Police, and Paramedics to transport you to the nearest emergency room.

Not all emergencies are deemed 911 worthy…

911 is not a taxicab

I want to go where my Healthcare Providers Are!

We are all responsible for our health and the proper utilization of healthcare benefits. Ambulance transport can be very expensive and we have choices that can keep money in our pockets if asking the right questions when considering Medicare ambulance transportation.

Let’s talk about Medicare Coverage of Ambulance Services:

Medicare Part B (Medical Insurance) covers ambulance services to or from a hospital, critical access hospital (CAH), skilled nursing facility (SNF) only when other transportation could endanger your health. Medicare will only cover ambulance to the nearest appropriate medical facility that’s able to give you the care you need. Additionally, Medicare covers medically necessary ambulance transport to/from dialysis and private residences. Using a Private concierge ambulance transport might save you money. They can pre-schedule your patient appointments and communicate with the destination’s nursing team.

What do I Pay for Medicare Ambulance services?

If Medicare covers your ambulance trip, you pay 20% of the Medicare-approved amount, after you have met the yearly Part B deductible.

Co-pays are another concern that can be considered when combined with the bill for service. Insurance Agents can provide knowledge of the right supplemental insurance to provide additional protection, coverage, benefits and the right co-pays for your conditions and needs.

What does Medicare pay for Ambulance services?

If Medicare covers your ambulance trip, Medicare will pay 80% of the Medicare-approved amount after you have met the yearly Part B deductible.

Not all concierge Ambulance services accept Medicare, so be sure and check with the provider.  (AirCare bills Medicare and client for co-pay, and also accepts cash payments for transports.)

Medicare Ambulance

How do I know if Medicare didn’t pay for my ambulance service?

You will get a Medicare Summary Notice (MSN) from the company that handles bills for Medicare. The notice will tell you why Medicare denied payment, such as “Payment for ambulance transportation is allowed only to the closest appropriate facility that can provide the care you need” or “Transportation to a facility to be closer to your home or family is not covered”

Remember, Research Your Choices….

Private Concierge Ambulance Transportation can be a great local solution for cost savings.  They can provide EMS trained and County Certified EMTs on ambulances to service you and your community at a Greatly Reduced Cost from calling 911.  A private ambulance can arrive silently into your neighborhood to take you to a hospital emergency room where your healthcare provider practices.

These cost savings can be up to 50% when you inquire with the Business Office or Dispatch regarding the nature of your transport. Your Private Concierge Ambulance provider will bill your insurance, releasing that task from your “To-Do List”.

Private Ambulance transportation services normally would like Medicare A/B or Insurance to pay for your ambulance expenses.

Here are questions to ask when scheduling a Medicare ambulance:

  1. Is this a Medical Emergency?
    • If your health is in serious danger, every second count to prevent your health from getting worse.  In that situation, call 9-1-1.          
  2. Is this a Non-Life Threatening Emergency?
    • If this is the case, you might be able to schedule your Medicare Ambulance services in advance.

If you are diagnosed or need to treat your health condition (and using any other transportation method would endanger your health), then in that situation, you can use a Non-emergency private concierge ambulance.

Medicare covers limited non-emergency ambulance transportation if you have a statement from your doctor that ambulance transportation is necessary due to a medical condition.
  1. Will they take me to my HealthCare Hospital of Choice?

Medicare reimburses to the nearest appropriate medical facility that is able to give you the care needed. You will be responsible for additional transport.

  1. Is this a Pre-scheduled elective surgical procedure?

If it is pre-scheduled, and Non-emergent, then using a Private Concierge Ambulance may save you money.

  1. Is this a Follow-up doctor’s appointment?

If it’s pre-scheduled, then it’s Non-emergent so you should consider using a Private Concierge Ambulance.

  1. Is this a Scheduled and necessary outpatient or inpatient procedure?

If it’s a scheduled outpatient or inpatient procedure, then it’s Non-emergent.  In that case, use a Private Concierge Ambulance.

Here are some of the issues we face when determining the need for transport:
  1. How Serious Is It?
  2. Life-Threatening or Non-Life Threatening?
  3. Does my insurance cover it?
  4. Could I go by Car, Concierge Private Ambulance or 911?
  5. Should I go to the Emergency room, Urgent Care or Dr. office?
  6. What is the cost comparison including insurance co-pays?

Remember, to ask yourself, “How Serious Is It” when calling for ambulance transport. Medicare covers Medical Necessary Ambulance transports with strict guidelines. If you find yourself needing this type of transport, it’s best to call a Private Concierge Ambulance to get a rate quote.  Many of these ambulance services will also bill Medicare for you.

When utilizing Medicare benefits it can be challenging to get answers for transportation reimbursement or your questions. Here are some Quick Facts you should know regarding Medicare and Insurance reimbursement when utilizing ambulance transport:

Medicare does not cover:
  • Ambulance transport from Skilled Nursing to Skilled Nursing, unless you are moving to a higher level of care
  • Transport to or from doctor’s appointments
  • Ambulance transportation for elected surgical procedures
  • Transportation by Ambulance to urgent care facilities

Since Medicare will not cover these items, it’s smart to pre-arrange for transportation with a Private Concierge Ambulance Service.

Alicia Sullivan works for AirCare Ambulance of San Diego, CA and can be reached at (760) 579.0223.

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