So you’ve had a medical situation that required emergency transportation and now you’ve received an unexpected bill. You may be wondering: does health insurance cover ambulance rides? Keep scrolling to check out the answer and learn what to do if your insurance refused to cover an emergency transport claim.
How Much Do Ambulance Rides Cost?
Without insurance, an ambulance ride can cost anywhere from a few hundred dollars to several thousand. Plus, depending on the kind of care you received while in the ambulance, you may be looking at much more. If you’ve been in an accident or suffered a severe health issue, the last thing you want is to have to spend that money for a service you needed during an emergency!
Does Medical Insurance Cover Ambulance Rides?
The first thing you need to know is that, if you are in a car accident, you should rely on car insurance, not health insurance, for the ambulance ride. If you have a comprehensive car insurance plan, chances are it will cover the cost of ambulance transportation without any copays in the event of an accident. (Of course, it’s worth double-checking with your car insurance that this is the case.)
Health insurance will only cover ambulance rides if they are considered medically necessary. However, that doesn’t mean they will come at no cost to you. You’ll still have to pay something out of pocket, whether it’s a copay, coinsurance, or a deductible.
Does Medicare Cover Ambulance Rides?
In order for Medicare to cover your ambulance ride, you’ll need to have Medicare Part B, which covers medically necessary transportation to the nearest medical facility. You’ll still have to pay a deductible, and probably something like 20% of the full cost of the ride.
Medicare also covers non-emergency ambulance transportation with participating providers in some situations. You will need a doctor’s note to prove medical necessity in this case.
Does Medicaid Cover Ambulance Rides?
Medicaid, like Medicare and private insurance, will cover medically necessary ambulance rides to the nearest medical facility. Some states do limit these services, so be aware that Medicaid’s coverage may be slightly different where you are.
Why Do Ambulance Rides Get Denied by Insurance?
Other than basic errors in documentation, the most common reason ambulance claims get denied by health insurance is that the ride was considered not “medically necessary.” If you had to get a ride in an ambulance, you probably didn’t do it just for fun, so this reason for denial may come as a slap in the face.
In some situations, the EMTs responsible for documenting the care you received in the ambulance may not properly record your condition and how you were treated. If EMTs—whether out of a lack of understanding or while rushing the process—don’t carefully document your emergency transportation, your insurance may decide that a ride was not critical to your care. This can be maddening if it’s happened to you, especially because there is nothing you can do until the claim gets denied.
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What is a Medically Necessary Ambulance Ride?
A medically necessary ambulance ride is one that was determined to be the safest way to transport someone to medical care. EMTs or physicians will need to prove that the person’s condition might have been worsened had they gone by another method of transportation. If a patient’s condition is life-threatening or may become life-threatening on the way to the hospital, an ambulance ride is medically necessary.
In non-emergency situations, a doctor may also recommend an ambulance ride. Most times a doctor’s note with a recommendation is enough to prove medical necessity.
So, if you needed life support during your ride to the hospital emergency room, an ambulance ride was undoubtedly medically necessary. If you’ve sustained a spine injury that needs to be stabilized as they head to a hospital, that would be medically necessary, too. However, if you ride to the hospital in an ambulance as a precaution when you were in a minor car accident and just have a few cuts and bruises, your insurance will most likely deny your ambulance claim.
Sometimes, the EMT or doctor who submits the claim paperwork to your insurance isn’t specific enough about your condition and why it warranted emergency transport. Maybe they leave out important care you received during your ride or fail to give medical evidence that another transportation alternative would have threatened your wellbeing. That’s all it takes for you to end up with a wrongly denied claim!
When Should You Get an Ambulance Ride?
If you want to be sure that your insurance will cover your transportation, save ambulance rides for emergencies. This means any time when an injury could be life-threatening, such as a heart attack, severe car accident, or if you or someone else needs CPR or resuscitation.
If you have a doctor’s appointment or minor health issue and don’t have a way of getting yourself to a medical facility, hold off on calling an ambulance. Instead, hail a taxi, book a ride with a rideshare app, or find a company that offers non-emergency medical transportation in your area.
What to Do About a Denied Ambulance Claim
Usually, when you get a ride in an ambulance it is an absolute last resort. Maybe you were severely injured in a bike accident or had a stroke at home. You probably weren’t even aware that you were transported by ambulance, so receiving a denied medical claim for your ambulance ride can make you feel helpless and confused.
If you believe that your ambulance claim should have been covered, you may have to fight your health insurance denial. But where do you start? How do you know if you are entitled to an appeal? Fighting a medical claim denial opens a whole can of worms as you face down a complicated process that feels as if it has been made intentionally unclear.
See What aJust Can Do For You
Luckily, there is no need to hire a lawyer or give in and pay the bill when you have aJust on your side. The experienced team at aJust has made it their mission to help people tackle unfair medical claim denials to get coverage for the services they needed. If you got stuck with the ambulance bill, hand over the paperwork to aJust and let them take care of the fight.
Because you only have one chance to get the appeal right, and you’ll need all the help you can get!