Am I Covered?
Unfortunately, there is not a simple answer to this question. The short answer is, probably, but it depends.
Most health insurance plans cover most of the cost of an ambulance transport. We've prepared the following guidelines below to help you determine if your trip is covered whether you are a Medicare recipient or the beneficiary of a commercial insurance plan.
- Medicare covers 80% of the cost of an ambulance transport provided that it has been deemed necessary by a medical professional.
- Definitions for medical necessity include: any medical emergency or situation that would appear to a layperson to be a medical emergency, or that transport of a patient who is non-ambulatory, cannot sit safely in a wheelchair, and requires transfer in a stretcher.
- More information about reimbursement can be found by visiting the Centers for Medicare and Medicaid Coverage Determination Web Page.
For Commercial Insurance
- Reimbursement for ambulance transports covered by commercial insurance providers will depend largely on the specifics of your plan.
- Like any other insured service, ambulance transports will be subject to the deductible in your plan.
- Most insurance providers typically reimburse Pro Care for a large percentage of the cost of the ambulance transport (this is determined largely by specifics of the plan and the premiums paid by the insured). The remainder is the patient's responsibility.
- If you anticipate requiring the services of a private ambulance firm and unclear about whether or not your transport will be covered, you should call your insurnace provider directly and ask them.
If you have questions about why you are receiving a bill from Pro Care, please feel free to contact our billing department.