Medicare and Commercial Insurance

Medicare: Ambulance transportation is a benefit included under Medicare Part B. Provided the transport meets medical necessity criteria and is a covered service, (Medicare does not pay for non-transport ambulance services or On Scene Care) Medicare will pay 80% of the legislatively regulated fee schedule after any applicable deductibles have been met. The remaining 20% is the patient's responsibility either to be covered by a supplemental insurance or private pay.

State Medicaid: Coverage requirements vary state to state and not all Medicaid benefit plans include coverage for ambulance services. You are responsible for providing your Medicaid information to our office for processing.

Commercial  Insurance:  For  your  convenience  we  will  submit  claims  to  private  insurances  including  Health  and  Auto.  We  can  only  submit  claims  for  which  we  have  complete  information  including  policy  numbers,  claim  submission  address,  and  group  name  and/or  number  (when  applicable).

If  wehave  submitted  your claim  to  your  insurance  and  you  are  receiving  this  bill  either  45  days  has  passed  without  a  response  or  payment  from  your  insurance  or  they  have  processed  the  claim  and  a  balance  remains  or  your  insurance  company  has  denied  a  portion  of  the  charges  citing  above  "usual  an  customary  charges".

It  is  important  to  know  that  Ambulance  Services  are  not  regulated  by  " usual  and  customary  charge "  and  you  remain  responsible  for  the  entire  balance.The  rate  structure  utilized  by  your  ambulance  provider  is  not  exorbitant  by  any  means;  their  rates  are  based  on  annual  surveyed  averages  of  ambulance  providers  in  their  geographic  area  and  most  importantly  by  operational  expense  governed  by  the  municipalities  which  own  the  service.

You  can  contact  your  insurance  company  to  see  what  appeal  or  reconsideration  options  you  can  pursue  to  see  if  they  will  make  additional  payment..

Medical Necessity

Medicare or state Medicaid

Medical  necessity  is  established  when  the  patient's  condition  is  such  that  use  of  any  other  method  of  transportation  is  not  appropriate.In  any  case  in  which  some  means  of  transportation  other  than  an  ambulance  could  be  used  without  endangering  the  individual's  health,  whether  or  not  such  other  transportation  is  actually  available,  no  payment  may  be  made  for  ambulance  services.  This  generally  means  the  patient  must  have  an  acute  injury  or  illness.

It  is  important  tonote  that  the  presence  (or  absence)  of  a  physician's  order  for  a  transport  by  ambulance  does  not  necessarily  prove  (or  disprove)  whether  the  transport  was  medically  necessary.

The  patient  has  the  right  to  appeal  this  determination  by  contacting  their  insurance  carrier  directly.

Lift Assist/No injury

Medicare and Medicaid only pay if there is medical necessity to be transported to a hospital by ambulance. Occasionally people fall within their home and call 9-1-1 or push a medical alert alarm for help. If the ambulance comes to your residence, we will assist you to a chair and provide a medical screening to determine if it is necessary to go to a hospital by ambulance. Medicare does not pay for the assessment or us coming to assist you, there will be a charge assessed to the person by the municipality.