March 04, 2016
This is a question you can't be asking yourself when an emergency is staring you in the face. Well, that's exactly when Medicare Part B (medical insurance) comes in handy. You are covered for ambulance (ground) transportation only if the situation warrants a need to be transported to a critical access hospital (CAH) due to an emergency. You can even get yourself (or whoever the patient is) to a skilled nursing facility (SNF) because Medicare will reimburse such expenses arising out of a sudden medical emergency cropping up out of the blue.
Ambulance to the rescue
This is because the patient may be too unstable to be transported by a cab or a car. This is especially so when a patient is in shock or has fallen unconscious suddenly, or is bleeding heavily due to a serious injury. This is when the patient will certainly need expert medical attention and/or treatment even while in transit. This sort of emergency treatment can only be given by paramedics accompanying an ambulance. However, these are just instances, and Medicare coverage will depend mainly on the seriousness of the cases, which may vary based on many factors. If the patient could have been transported safely by any other means, Medicare may not be applicable.
Being flown during an emergency
If the situation warrants, Medicare pay for ambulance transportation by helicopter or airplane. This will, of course depend on the health condition of the patient where he or she needs immediate medical attention (life threatening). When speed is of essence and ground transportation will be quite inadequate, Medicare pays for a patient who needs to be flown to a hospital. This is applicable in cases where the terrain in the pickup location is not very favorable for ground transportation. It is also applicable when the patient needs to be transported long distances, and could be delayed by heavy traffic. However, Medicare pays only for ambulance services, both ground and air, only to the nearest medical facility that can provide emergency medical attention.
Some instances not covered
Although Medicare pays for emergency ambulance transportation, there are a few instances that Medicare will not reimburse the expenses. For instance, wheelchair van transportation is not covered by Medicare. Similar is the case with paramedic intercepts, where Medicare usually does not pay. If a patient wishes to be transported from his or her residence to the physician's office, Medicare does not reimburse ambulance transportation expenses. In non-emergency cases, the ambulance supplier needs to obtain a certificate from the physician stating that ambulance transportation is absolutely necessary as other forms of transportation can be risky.
Other cases where Medicare pays
There are some other specific cases where Medicare pays for ambulance transportation. If the patient needs to be transported to a skilled nursing facility from a hospital or vice versa, Medicare pays. If the patient could not get appropriate care at the first hospital, he or she may be transported to another hospital by ambulance for which Medicare will again pay. The same applies for being transported from a skilled nursing facility to another one due to lack of availability of expert medical care. Patients needing dialysis due to end-stage renal disease are eligible for round-trip ambulance transportation from home to the nearest skilled nursing facility or any other that provides renal dialysis. One point to remember is that the provider has to be Medicare certified.
In most cases, Medicare denies coverage, and if during any instance the denial was for a beneficiary who was actually eligible, it is best to appeal. It makes sense to learn which cases are eligible for ambulance transportation and be prepared well before an emergency crops up.