OKLAHOMA CITY – It can be complicated when you are forced to call 911 for an ambulance, especially if you’re on Medicare.
An unexpected ambulance bill can be devastating since a charge for a single emergency ambulance ride can cost more than $1,300.
Fortunately, Medicare covers ambulance rides but there are exceptions.
First, it means that your medical condition must be serious enough that you need an ambulance to transport you safely to a hospital or other facility where you receive care that Medicare covers.
If a car or taxi could transport you without endangering your health, Medicare won’t pay. For example, Medicare probably won’t pay for an ambulance to take someone with a simple arm fracture to a hospital. But if he or she goes into shock, or is prone to internal bleeding, ambulance transport may be medically necessary to ensure the patient’s safety on the way. The details make a difference.
Second, the ambulance must take you to the nearest appropriate facility, meaning the closest hospital, critical access hospital, skilled nursing facility or dialysis facility generally equipped to provide the services your illness or injury requires.
So, if you live in a rural area where the nearest hospital equipped to treat you is a two-hour drive away, Medicare will pay. But if you want an ambulance to take you to a more distant hospital because the doctor you prefer has staff privileges there, expect to pay a greater share of the bill. Medicare will cover the cost of ambulance transport to the nearest appropriate facility and no more.
In limited cases, Medicare will also cover non-emergency ambulance services if such transportation is needed to treat or diagnose your health condition and the use of any other transportation method could endanger your health. Not having another means of transportation is not sufficient for Medicare to pay for services.
Some examples here are if you need transportation to get dialysis or if you are staying in a skilled nursing facility and require medical care. In these cases, a doctor’s order may be required to prove that use of an ambulance is medically necessary.
The cost for ambulance services can vary from several hundred to several thousand dollars depending on where you live and how far you’re transported.
Under original Medicare, Part B pays 80 percent of the Medicare-approved amounts for ambulance rides. You, or your Medicare supplemental policy (if you have one), will need to pay the remaining 20 percent.
If you have a Medicare Advantage Plan, it must cover the same services as original Medicare, and may offer some additional transportation services. You’ll need to check with your plan for details.
How to Appeal
If an ambulance company bills you for services after Medicare denies payment, but you think the ride was medically necessary, you can appeal (see Medicare.gov/claims-appeals). Often, a lack of information about a person’s condition or need for services leads to denials.
For more information on this topic, call Medicare at 800-633-4227 and ask them to mail you a copy of the “Medicare Coverage of Ambulance Services” booklet, or you can see it online here.
If you need some help contact the Oklahoma Senior Health Insurance Counseling Program (SHIP), which has counselors that can help you file an appeal for free. To locate your local SHIP, visit map.oid.ok.gov or call 800-763-2828.
Before you need an ambulance ride, Oklahoma City residents have the option to opt-in to the EMSAcare program. You can opt-in during the month of September by calling (405) 297-2833 or by clicking here.
EMSAcare costs $3.65 a month, which is added to your monthly city water bill.