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How Much Does Ambulance Ride Cost & Do Insurance Cover Them ?

does medicare pay for ambulance
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Ambulances and Emergencies are desperate terms in the line of medical needs. There’s no doubt with the fact that Ambulances save lives, helps get the immediate medical attention needed and ensures that you get to the hospital good. But, the ambulance bill might come out a shocker. That’s right! Ambulance bills and the trip charges are burning holes in the people’s pockets. Years before, the ambulances were free for patients and provided services with the help of tax payer’s money, but now, the patients are charged with unexpected bills for the ambulance services. Its become a million-dollar question. Does your health insurance or medicare cover ambulance? First lets know how much does an ambulance cost and then we know whether insurance covers them.

How Much Does An Ambulance Ride Cost?

The cost of ambulance services varies drastically depending on the distance, medical equipment, services / medical first aids given and sometimes its charged for every mile covered instead of whole distance in-between point of pick up to destination hospital. So next time when we think of how much does ambulance ride cost, the answer is not going to be a simple one. Moreover, ambulance services are varied like for example in some county’s ambulances are taken care of by fire departments, volunteers, municipal EMS providers and by ambulance companies.

Average Cost Of Ambulance Ride

According to a report from US Govt. Accountability Office, the average cost of ambulance ride is given below
The ambulance ride charges range from a $224 – $2204 per transport (Medicare Beneficiaries)In case you have health insurance, then ambulance service charge out-of-your-pocket will come around $15-20 to $100If you don’t have Health Insurance, then the ambulance charges depend upon the Distance, your location, whether it’s an emergency need or a scheduled transport to hospital, basic life support services, other medical equipment’s and sometimes for every mile covered. In that case:

  • Without Health Insurance, the Ambulance service Charge out of your pocket would be from $250-400 – $1200 or more.
  • If cities cover ambulance charges by taxes then you won’t have to pay anything.

Depending upon Cities, County, Town, Ambulance Services & their affiliation with Insurance Companies the ambulance service charge varies and you cannot pin down to fixed dollars.

For Example: Ambulance Charge for Non-Emergency with Basic Life Support will come around $350-$375

Whereas, Ambulance Charge for Emergency with Advanced Life-Support can come around $600 – even $1000

Some cities offer Ambulance Services Membership Plan for a monthly charge of $2.50 – $3 so that you don’t have to pay out-of-pocket.

For Non-Members, the ambulance charge would come around $1000 – $1200 with an extra $9 per mile

Woodburn Ambulance Service charges around $1200 plus $20 per mile for non-members of their membership plan. So the charge for ambulance ride varies from place to place.

Private Ambulance Costs

Unlike the US Emergency Medical Services (EMS), who takes care of medical emergencies from 911, the private ambulance services are not much regulated in terms of charges. They charge based on a particular base rate (mostly fixed by them), per-mile charges, additional care, night travel, weekend charges, and others.

For Emergency Basic life support or if it’s a Non-Emergency, the charge comes around $400 with $6.50 Per Mile

Private Ambulance Services have charges based on Advanced Life Support in Two Categories i.e.

Advanced Life-Support Level 1 comes around $450 + $6.50 Per Mile

Advanced Life-Support Level 2 can come around $875 + $6.50 Per Mile

If it’s a non-emergency you can opt for private ambulance services and if it’s an emergency the quick 911 will help.

Additional Ambulance Costs

Additional ambulance services cost varies depending upon cities, ambulance services and even sometimes the insurance companies who are affiliated with the ambulance providers might have a take on incurring additional costs.

In general, additional ambulance cost can come like

Separate charges for Medical Supplies like Bandages, Ice-Packs, IV supplies, Catheters, Saline, Sterile needles/gloves will add $100 or even more (in some cases $1000) to the final ‘ambulance service bill’.

Charge for Oxygen Mask around $24-25

Charge for Burn-Kit or Obstetrical Kit can come around $45.25

In advanced needs, Charge for Infusion pump/pulse oximeter can come around $75-80.25

If there is a more advanced emergency, then the life-saving kit is going to cost you more than $100

What Can You Expect From Your Final Ambulance Bill?

The Ambulance billing and charges should be mandated according to the National Ambulance Fee Schedule (FS) and it applies to all ambulance transports. Medicare/ Health Insurance pays for the ambulance transports either as a package or as a separate billing service.

Payments for Ambulance transports (under Ambulance FS) will include:

  • Includes a base rate payment (level of service provided) + separate payment for mileage to the nearest hospital facility.
  • Life support usage charges
  • Total Distance charge
  • Medical supplies charges
  • Medical Kits Used – Ex: Burn/Obstetrical/Pediatric Emergency/Trauma/Kits for taking care of Blood-Loss & other severe injuries that needs on-the-spot aid and such.
  • In case of advanced life support care/life-threatening emergency needs like CPR, medicine administrations (if any), breathing tube insertion, immediate sutures/stopping injury in any form in case of severe blood loss and other needed treatments.
  • Will cover medical crew wages, Fuel, Maintenance also.
  • Precludes a separate payment for items and services furnished under the ambulance benefit.

These are some of the major charges that will be included in your Ambulance Service Bill and it might not be the best list but it covers all branches of the total charge calculated for the Ambulance Services. We don’t want you to have it but in case you got an ambulance bill in your hand, you can make a mental note of the charges incurred.

 

What If We Call 911 For Ambulance? Will I Get An Ambulance Service Charge Bill? Will It Be Covered By Health Insurance?

How much does ambulance ride cost? Usually, the 911 emergency – Ambulance charges depend upon where you are, which county you belong and their regulations.

When you call 911 Emergency, they in-turn will call the EMS Ambulance Services. The ambulance charge through 911 varies from EMS agencies. Some ambulance agencies will not charge you for 911 emergency responses and after arrival, they will examine you, give some aid and finally if all goes well and you don’t wish to transfer to hospital then there’ll be no major charges. You might want to pay a little sum for the ambulance service (even that might come near $100).

In case you got an emergency and you need to be taken to the hospital then the 911 emergency ambulance call of EMS will be charged and in case if the ambulance service provider has affiliation with health insurance the bill coverage is possible. The bill will be mailed to you or in case of the health insurance by the patient,the bill might get covered to certain % of the original.

Even if it’s a 911 emergency ambulance, the health insurance will pay if the ambulance is being called upon “serious medical conditions” or in need of hospital treatment for the patient.

In different places/cities, the ambulance charges Even the Air-Ambulance services will be taken care of from tax payer’s money.

But still, at the end of the day, your ambulance with the equipment, crew, drugs, and others will need some charge to assist them to do their job well.

Does Insurance Cover Ambulance Charges & If Covered What Are The Ambulances Charges Are Covered?

Insurance Coverage, Billing & Payments on Ambulance Services

The Health Insurance like medicare or Medical Insurance will only pay for the ambulance services when the patients are transported to the hospitals for further treatments or when the ambulance service is called upon serious medical emergency like life-threatening situations. If the ambulance is for a simple medical-aid or help, the Health Insurance doesn’t cover the bill.

For ex: In a situation where there’s an emergency like choking, small injury or any mild medical needs, then EMT or paramedic’s first-aid can help and the patient will not have any need to go to the hospital. In that case, the health insurance will not cover your ambulance charges and when the bill arrives from the ambulance provider you need to pay from your own pocket.

In case, if there’s an emergency concerning serious issues/life-challenging medical conditions like heavy blood loss, heart conditions, trauma, harsh accident, head injury, critical obstetrical conditions then the paramedics/EMS ambulance services will have the need to transport you to the nearby hospital for further treatments apart from the first-aid and checkup they do. The usual thing is that, once you’re okay and out of the hospital, the ambulance bill’s going to come knocking your door.

Does Medicare Cover Ambulance Service Charges ?

Even in covered medical situations, Medicare and other health care policies will only pay 75-80 % percent of your ambulance bill and the remaining will have to be from your own pocket.

Conditions To Be Met For Insurance To Cover Ambulance Bill

Medicare and health insurance providers will cover your ambulance service bills if they come under criteria’s like:

  • The Medicare/Health insurance will cover for ambulance services to the nearest hospital which should have appropriate standards and can offer fitting level of care.
  • The patient’s choice or their own picking of the hospital might not be considered by them i.e. you cannot pick the hospital facility you want to go. If the medical facility doesn’t have proper care/equipment’s to treat your medical conditions then the ambulance will take you to the next closest hospital with good facilities.
  • If the ambulance takes you to a second facility that is fully equipped, then the insurance will cover both ground kinds of transport (i.e. includes first transport to the local hospital) by the ambulance provided the facility is near-by and not out-of-the-area.
  • In case, if the patient needs ambulance transport to and from nearby hospital facilities for any Scan/Diagnosis/Therapy then the insurance will cover the bill only to the extent of payment that would have been made to bring the service to the patient/beneficiary.
  • In Non-Emergency Situations, the Medicare / Health Insurance will cover your ambulance bill if:
    • If you are bed-ridden and cannot travel to the hospital by any means other than ambulance. In which case, the insurance will cover the bill (but mostly, they don’t, the reason is not sufficient for them always).
    • If there’s a need for medical care or crew during the transport.
    • In some cases, for example: if you are taking treatment in a nursing facility then the doctor’s order is needed to say that the patient needs to use the ambulance. In this case, Medicare will cover your ambulance bill.
  • Medicaid will cover the emergency ambulance service charges only when the service is provided by licensed Ambulance Service provider by the respective State. The vehicle in which the patient is to be transported must be examined, inspected and issued a permit by the state and only then the Medicaid will accept the claim.
  • In the case of Non-Emergency services, the Medicaid will cover the ambulance bill only if the doctor gives a statement on the ‘need for an ambulance for transport’. Other cases will not be considered.
  • Medicaid covers the ambulance/emergency medical transportation costs for eligible individuals in non-emergency with conditions like:
    • You should be On-Time for Pickup and you should call the ride to cancel a scheduled-pickup.
    • You should know the time limit of how long the driver can wait, so always be on time for the pickup.
  • Major health insurance, Medicare and Medicaid facilities will have Ground Ambulance coverage requirements like:
    • Ambulance transport is medically necessary.
    • The Insurance-beneficiary is being transported to the hospital facility.
    • The hospital destination should be local.
    • The facility is appropriate and well equipped.
    • Insurance will cover the ambulance transport of the patient from the hospital to their home if the location is near to the hospital area.
  • Billing & payment coverage for the ambulance transports depends upon the insurance provider.

Do Your Car Insurance Pay For Ambulance Services?

What happened during a car accident and will car insurance cover my ambulance bills? Well, the answer is Yes! But not all car insurance will take care of your ambulance bills and not all types of car insurance will apply in all medical situations. Let’s see the type of car insurance that covers the ambulance bills.

  1. Personal Injury Protection (PIP) Coverage: if you’re insured under the PIP coverage and you live in a No-Fault State (i.e. because of their mandatory requirement of PIP coverage), then the coverage will pay for your medical bills including the ambulance costs. You don’t have to worry about who caused the accident.
  2. Medical payments: This coverage will pay for your Ambulance rides and it’s an optional coverage plan. It’s provided by the states who don’t need PIP coverage.
  3. Bodily Injury Liability Coverage: In case if the accident is due to the other driver, then that driver’s Bodily Injury Liability Coverage will pay for your ambulance ride and they cover your other medical costs.
  4. Uninsured Motorist Coverage for Bodily Injury (UMBI): If the fault is other drivers and he doesn’t have liability coverage, Uninsured Motorist Coverage will pay for your ambulance ride.

In case there is an insurance coverage overlap like who needs to pay first , is it the car insurance or other driver’s insurance policy or my health insurance policy then the order will vary i.e. car insurance will kick in first. The order varies depending upon the state, state laws, insurance provider’s remarks, and others.

Final Thoughts

No one wants a medical emergency but we can’t be sure all the time. At the time of emergency we might not have time to think about bills, payments and insurance coverage’s and all we think of is that the person suffering should be safe and should get proper treatment on time. It’s good to take a look into the insurance coverage when it comes to all ambulance transports and facilities so that you can get to know about utilizing the ambulance service coverage and other medical coverage. If you find the time, you can get a clear view of health insurance personal. Ask them how much does an ambulance cost and does your insurance cover ambulance Instead of last-minute ambulance shocker bills, you might become aware of health insurance nuances around you.