NEWS RELEASE
Pearl W. Stanley
Extension Agent
Family and Consumer Sciences, CFCS
Bolivia, NC 28422
June 2003
Most people do not think of insurance coverage when calling an ambulance in an emergency situation. But what about the times when ambulance transportation is needed when there is no emergency? People with Medicare have certain guidelines to follow before calling an ambulance.
Medicare Part B covers ambulance services to or from a hospital or skilled nursing facility in an emergency only when other transportation would be dangerous to your health. In addition, Medicare may also pay for ambulance transportation in special situations that your doctor considers medically necessary.
However, be aware that Medicare issues many denials for ambulance coverage. The following guidelines should help in making a decision regarding when to call an ambulance.
Emergency Ambulance Transportation
Emergency ambulance transportation is provided after you have had a sudden medical emergency, when your health is in serious danger and when every second counts to prevent your health from getting worse.
Ambulance transportation may be considered medically necessary if you:
Medicare will only cover ambulance services to the nearest appropriate facility that is suitable for your medical condition. If you choose to be transported to a facility that is farther away, Medicare’s payment will be based on the charge to the closest facility.
Medicare will pay for emergency transportation in an airplane or a helicopter if your health condition requires immediate and rapid ambulance transportation that cannot be provided by ground transportation.
Non-emergency Ambulance Transportation
If you are confined to your bed or your medical condition makes ambulance transportation medically necessary, Medicare may cover the service if you have a written order from your doctor. Medicare coverage of non-emergency ambulance transportation is very limited.
What does Medicare Pay?
If Medicare covers your ambulance trip, Medicare will pay 80 percent of the Medicare approved amount after you have met your annual Part B deductible ($100 in 2003). You are responsible for the remaining 20 percent. The ambulance company cannot charge you more than 20 percent of the Medicare approved amount. All ambulance companies must accept Medicare assignment. This means that the ambulance company must accept the Medicare approved amount as payment in full.
The above guidelines pertain to Medicare coverage of ambulance services if you are under the Original Medicare Plan. If you are in a Medicare+Choice Plan, you may have different rules, so check your benefits pamphlet. However, your plan must offer you at least the same coverage as in the Original Medicare Plan.
For answers to your Medicare questions or any senior health insurance questions call SHIIP's toll-free Consumer Line (1-800-443-9354). You may also visit www.ncshiip.com or e-mail shiip@ncdoi.net for answers to your questions. In addition, SHIIP trains volunteers in local communities who are available for free, one-to-one counseling sessions. To reach a SHIIP counselor in your area, contact:
Pearl Stanley
Extension Agent
Family and Consumer Education, CFCS
P. O. Box 109,Bolivia, NC 28422
Telephone: (910) 253-2610
Fax: 910-253-2612
E-mail: Pearl Stanley
(The Seniors' Consumer Column is written monthly by the SHIIP staff. The column is a service of SHIIP, which is a division of the North Carolina Department of Insurance -- Jim Long, Commissioner.) P. O. Box 26387, Raleigh, NC 27611; 1-800-443-9354, (919) 733-0111; www.ncshiip.com
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Date Created 6/12/2003