|
Medicare
ambulance benefits, covered under Part B of traditional
Medicare, are often confusing and hard to understand.
Here's a basic guide to understanding your ambulance
benefits. This information applies to traditional
Medicare only. If you are covered by a Medicare + Choice
plan, other rules might apply:
Medicare covers ambulance
transportation when other means would be dangerous to
the patient's health. If the patient could
have been transported by other means without danger,
then Medicare will probably not cover the trip.
Example: You fell and have possible back and neck
injuries. Ambulance transportation is appropriate because
moving you any other way could be dangerous.
Example: You fell and your wrist may be broken.
You are in pain, but you can move around. Ambulance
services will not be covered because there are other,
equally safe, means of transportation. Medicare doesn't
think that having no one
available to drive you is a good reason to pay for an ambulance.
Medicare will pay for
transportation to the nearest facility that can provide
the necessary medical services.
Example: You have a real medical emergency -
possibly a heart attack, stroke, severe bleeding, or
something equally severe.
Your preferred hospital isn't the closest hospital. In
spite of where you want to go the ambulance will take you to
the closest hospital that can deal with your medical
problem.
Example: In the case of severe injury the
ambulance might even go to a more distant hospital that
is better equipped to
deal with special emergencies such as burns, gunshots or
multiple trauma.
Non-emergency transportation is
covered only when there is no other safe way to
transport you to diagnose or treat a medical condition.
When the
trip is not an emergency you must have a doctor's statement that
transportation by ambulance is medically necessary.
Example: Your bedfast husband needs to see the
surgeon in his office for treatment of wounds. The
surgeon wrote a statement on his letterhead saying the
treatment is necessary and that no
other means of transportation is medically safe. The
ambulance service submitted the surgeon's statement with
their bill to Medicare. Medicare paid the bill.
Example: The surgeon said your bedfast husband
must come in for treatment and recommended that he use an
ambulance. After the trip Medicare refused to cover the
ambulance as not medically necessary. The surgeon did
not write a letter of medical necessity. This can be
corrected if he writes a letter and you give it to
the ambulance service to include when they re-submit
their bill.
Example: You have been treated in the hospital
for a medical condition that will require more treatment
or rehabilitation in another facility. You can only
travel safely between facilities by ambulance. Medicare
will cover the transfer trip.
Non-emergency
transportation that is not necessary to diagnose or
treat a medical condition is not covered, even if the
patient cannot travel by any other means.
Example: Your mother is medically stable in a
hospital or nursing home far away and you want to bring
her to one closer to you. Medicare will not cover this
trip because it is not medically necessary. You will
have to hire a private ambulance.
How
Much Will Medicare Cover?
Your traditional Medicare (Part B) will cover 80% of the
approved ambulance transportation charges. You, or your
secondary (MediGap) insurance company, are responsible
for the other 20%. Make sure that the ambulance company
has complete information about your secondary insurance
so they can submit their claim directly.
Often Medicare denies a claim because wrong or
incomplete paperwork was submitted by the ambulance
company. If this is the case, request that the service re-file
with Medicare. Don't pay the bill unless they have
re-filed and you have been denied a second time.
If you receive a denial of payment from Medicare you
have the right to appeal. On the back of your "Medicare
Summary Notice" there is information about why your claim
was denied, what steps you should take to file an
appeal, and how long you have to do so.
|
