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Caring for our community one patient at a time since 1985

Medicare Questions and Answers

Table of Contents

  1. Does Medicare pay for ambulance service?
  2. What does "Medically Necessary" mean?
  3. What hospitals can I be transported to and still expect Medicare to pay?
  4. Does LifeMed accept assignment from Medicare?
  5. How much of my ambulance bill will I be responsible to pay?
  6. Will you file my Medicare claim for me?
  7. Does Medicare pay for other types of medical transportation?
  8. What is an Advance Beneficiary Notice?

Does Medicare pay for ambulance service?

Medicare Part B pays for "Medically Necessary" ambulance transportation as long as certain conditions are met. Essentially, Medicare will pay for ambulance transportation during a medical emergency or for non-emergency transportation provided the patient is bed-ridden, the transport is to or from a hospital or free-standing dialysis center and it is cheaper to take the patient to the required service than it would be to bring the service to the patient.

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What does "Medically Necessary" mean?

For Medicare to pay for ambulance transportation it must be medically necessary. This means that in an emergency it must be as a result of a sudden onset of a condition of sufficient severity that any other form of transportation would place the patient's health at risk. In the case of non-emergency transportation the transport must be to obtain a necessary medical evaluation or treatment and the patient must be unable to get out of bed without assistance and unable to walk or sit in a chair and any other form of transportation would present a risk to the patient's health or safety.

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What hospitals can I be transported to and still expect Medicare to pay?

Medicare only covers ambulance transportation to the closest hospital that has the services you require available. If you wish to be transported to a further hospital you will be responsible for any additional mileage charges.

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Does LifeMed accept assignment from Medicare?

Yes, we do accept assignment from Medicare.

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How much of my ambulance bill will I be responsible to pay?

Medicare will pay 80% of the allowed amount for covered ambulance services. You or your supplemental insurance will be responsible for the remaining 20%.

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Will you file my Medicare claim for me?

Yes, our business office will automatically file your Medicare claim for covered services.

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Does Medicare pay for other types of medical transportation?

No. Other types of medical transportation such as wheelchair vans are not covered by Medicare.

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What is an Advance Beneficiary Notice?

Medicare requires healthcare providers and suppliers to notify you if they feel that a service you have requested will not be covered. They are also required to notify you of the reason why the service is expected to not be covered as well as an estimate of how much you may have to pay for the service if you still want it. The Advance Beneficiary Notice (ABN) is the form that is used to notify you of this. It also allows you to indicate if you want the service, whether or not you want us to try to bill Medicare for it so you can get an official ruling about coverage or if you wish to decline the service. The ABN also gives you the right to appeal Medicare's decision if they determine the service is not covered.

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Additional questions? Feel free to call our business office at (260) 982-8363.

Revised: June 14, 2013 .

 

 

2013 LifeMed, Inc.