Sometimes, a Good Samaritan turns out to be anything but.  That’s how Delores Cantz feels about an episode in March, when the 82-year-old slipped and fell while dancing at a party in Warminster, Pennsylvania.  Cantz said that after the fall she got up and walked to a side room, where — to her surprise — a crew from the nonprofit Warminster Volunteer Ambulance Corps was waiting to evaluate her and take her to a local hospital.  She refused what she thought was an unneeded emergency-room visit.  The result was a surprising $500 bill from the ambulance company.  That’s more than Medicare would allow for an actual transport to the hospital.

Unexpected ambulance bills are just one of many financial pitfalls for the elderly on fixed incomes, which means an unexpected bill can be a hardship.  In Cantz’s case, paying that $500 bill would eat up nearly half of her monthly Social Security check.

Cantz might have been better off financially if she hadn’t turned down the trip to the hospital.  Then her Medicare Advantage plan likely would have paid part of the ambulance bill, plus hospital charges — an example of how financial incentives can steer people toward choices that cause higher overall spending in the health-care system.  (Source: Philadelphia Inquirer)

How Does Medicare Cover Ambulance Transport?

According to the Center for Medicare Advocacy, Medicare will only cover the cost of ambulance transport under the following conditions:

1. Travel by ambulance must be the only safe means of transportation available. It is not sufficient that alternative transportation cannot be arranged. It is necessary to show that the patient’s health would have been jeopardized had he or she been transported any other way.
2. Transportation by ambulance must be:

• From any location to the nearest hospital or skilled nursing facility that can provide the appropriate level of care for the patient’s illness or injury;
• From a hospital or skilled nursing facility to the beneficiary’s home;
• From a hospital to a skilled nursing facility;
• From a skilled nursing facility to a hospital;
• From a hospital to another hospital or from a skilled nursing facility to another skilled nursing facility if the original institution could not provide the appropriate level of care for the patient’s illness or injury;
• Round trip transportation from a skilled nursing facility to another provider for medically necessary care not available in the skilled nursing facility.
• Round trip transportation from a patient’s home or skilled nursing facility to the closest facility that provides renal dialysis for patients living with end-stage renal disease.

3. Non-emergency transportation will only be covered if the ambulance supplier obtains a physician’s certification indicating that ambulance transportation is necessary because other means of transportation are medically contraindicated.
4. The transportation must be provided by a Medicare-certified provider.

Other Important Points:

1. Medicare does not cover wheelchair van transportation.
2. Medicare usually does not pay for paramedic intercepts.
3. Medicare will not pay for transportation from the patient’s home to the patient’s physician office.
4. Ambulance providers often do not inform patients that they do not think Medicare will pay for the transportation. In a non-emergency situation, it is a good idea to ask whether the transportation will be covered before taking the trip.

Billing Information:

1. Most medically reasonable and necessary ambulance transportation is covered by and billed to Medicare Part B. Thus the Medicare payment is subject to Part B deductible and co-insurance.
2. If the patient is an inpatient at a hospital or skilled nursing facility (SNF) on the day of the ambulance transportation (not the day of discharge), the transportation may be arranged by and billed to the hospital or SNF.
3. If the patient is enrolled in hospice and the ambulance transportation is related to the terminal illness, it should be arranged by and billed to the hospice provider.

Appeal:

Ambulance transportation is frequently inappropriately denied Medicare coverage.  If a Medicare beneficiary’s transportation meets the coverage guidelines described above, but were denied Medicare coverage, appeal!  Review the Medicare Summary Notice to determine the reason for the denial and follow the directions regarding how to appeal.  Send a letter with the appeal request explaining why the transportation was medically necessary.  Also, if possible, attach a supportive letter from the beneficiary’s physician.

http://www.medicareadvocacy.org/medicare-info/medicare-part-b/ambulance-coverage/