How Medicare covers your ambulance services
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By David Sayen  September 13, 2013 12:00 am

 I certainly hope you never need an ambulance, but at some point you may have to take one during a medical emergency.

If you have original Medicare, your Part B (medical insurance) covers ambulance services to or from a hospital, critical-access hospital or skilled nursing facility only when other transportation could endanger your health.

In some cases, Medicare may cover ambulance services from your home or a medical facility to get care for a health condition that requires you to be transported only by ambulance. 

Medicare may also cover ambulance services to or from a dialysis facility if you have End-Stage Renal Disease and other transportation could jeopardize your health.

Emergency ambulance transportation is provided after you’ve had a sudden medical emergency, and every second counts to prevent your health from getting worse. 

Here are some examples of when Medicare might cover emergency ambulance transportation: You’re in severe pain, bleeding, in shock, or unconscious; you need oxygen or other skilled medical treatment during transportation.

 Medicare will only cover ambulance services to the nearest appropriate medical facility that’s able to give you the care you need. If you choose to be transported to a facility farther away, Medicare’s payment will be based on the charge to the closest appropriate facility. If no local facilities are able to give you the care you need, Medicare will help pay for transportation to the nearest facility outside your local area that’s able to give you the care you need.

Medicare may pay for an air ambulance (airplane or helicopter) if your condition requires immediate and rapid transportation that a ground carrier can’t provide, and your pickup location is either hard to get to by ground transportation or long distances or heavy traffic could keep you from getting care quickly.

Non-emergency ambulance transportation may be covered when you need it to diagnose or treat your condition and any other mode of transportation could endanger your health.

If the ambulance company believes Medicare may not pay for non-emergency service because it isn’t medically necessary or reasonable, they must give you an Advance Beneficiary Notice (ABN). 

The ABN has option boxes that allow you to choose whether you want the service and explains your responsibility to pay for it.You won’t be asked to sign an ABN in an emergency situation. 

You can appeal if Medicare doesn’t pay for the ambulance trip and you believe it should have. If Medicare covers your trip, it will pay 80 percent of the Medicare-approved amount after you’ve met the Part B deductible ($147 in 2013). You pay the remaining 20 percent.

 

David Sayen is Medicare’s regional administrator for Arizona, California, Nevada, Hawaii and the Pacific Territories. Answers to your Medicare questions are available by calling 1-800-MEDICARE (1-800-633-4227).

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