When will Medicare cover ambulance transport?

"Ambulance services. Medicare Part B (Medical Insurance) covers ground ambulance transportation when you need to be transported to a hospital, critical access hospital, or skilled nursing facility for medically necessary services, and transportation in any other vehicle could endanger your health."

I think it really has to do with how the ambulance will code the transport.

Make sure any facility your husband was taken to such as an ER, hospital, or rehab and the ambulance company does the claim right. When the ambulance company coded my mother’s transport the wrong way, we got stuck for a $700 transport, one way. Appealing it didn’t help.

If it's an emergency Medicare will pay. No admittance necessary. At least they always have for my mom. A fall down stairs resulting in an injury for a 74 year old should counts as an emergency.

Medicare will pay for ambulance transport if the person cannot be safely transported by car or wheelchair van. If someone has been hospitalized the social worker or case manager needs to complete a letter of medical necessity to certify that the person requires ambulance transport. Given your situation, I would suggest contacting the ambulance company and ask to speak to the biller. They should able to advise you regarding coverage. If you are a member of the ambulance company that transported him, if you should receive a bill, you may receive a reduced rate. Your best bet is to call them though.

An Advantage Plan may have more restrictions on ambulance payment than traditional Medicare. There is no "network" requirement with traditional Medicare.

Another negative for Advantage Plans.

They have never paid for my mom, even in emergencies.

Try calling them and telling them you can’t afford the bill. My mother calls every time and tells them it’s too much money and she can’t afford to pay it. She is 95 years old and they just right off the bill. She hasn’t paid yet for an ambulance.

My mom had a co-pay amount and had to pay the rest. She lives on SS and pays for AL facilities, there is not much left. She told them (wrote a note on bill) she couldn't pay it all at once and was sending 25.00 a month. They keep sending her the bill every month and she paid only 25.00 until the full amount was paid.

Just watch the billing on this one. As long as it was coded as a medical emergency when it was sent to Medicare, it will pay. Errors can be made, however, and you can appeal and quite easily win a reversal.

1)My mom required medical transport via ambulance/laying down from hospital to rehab. Hospital used correct language and Medicare paid. 2) Sodium level became critical and they had to transport her back to hospital. Facility used wrong code and Medicare denied payment. 3)After a few days, hospital sent her back to another rehab and Medicare approved payments.

I appealed the #2 transport denial and used transport #1 and #3 as examples to justify medical necessity. If she was approved for transport when she no longer needed hospitalization, she certainly needed it when she was critical and require hospitalization. Medicare approved the #2 transport and paid it.

You should have no problem; unless there is some error in the claim submission. If you do not want to wait for Medicare’s payment call the EMS office and ask for a copy of the ambulance run report. It will indicate if the trip was medically necessary.