Smart Steps To Battle Unwanted Bills
If you get stuck with a high air-ambulance bill, industry experts and consumer advocates say there are things you can do. Ask your insurance company to advocate on your behalf, or challenge the bill directly with the air-ambulance provider. To bolster your odds, file a formal complaint with the appropriate agency in your state government. Some air operators also offer charity-care programs.
To avoid these bills, you might want to consider a membership program offered by some air-ambulance operators, particularly if you live far from a hospital. The programs, which cost as little as $65 per year, are meant to cover costs that your insurance doesnt pay. But that works only if the ambulance company you sign up with is the one that arrives at your emergency, something you may have little control over.
As for the Stouts, they have exhausted their appeals and are now contemplating filing a class-action lawsuit. Jennie says she wishes she had questioned the need for an air ambulance the day her daughter was hurt. Her advice to others in a similar situation? If it doesnt seem right, ask questions.
Is Air Ambulance Service A Good Idea
There are many private air transport services available. They’re often geared toward travelers who would like to be able to fly back to their home doctor or hospital to be treated if they happen to need care while they’re away from home.
These are great services, but they may not provide for all needs. Contact your insurer prior to making any commitment, or you may find that your claim isn’t approved.
Private air ambulance providers often have an insurance coordination service, so be sure to find out if they can help you with your insurance and outline what costs will or will not be covered. The best thing to do is to make sure you ask plenty of questions. Read any contracts with care before committing.
What If Medicare Still Won’t Pay
If you have Medicare, you have certain guaranteed rights to help protect you. One of these rights is the right to a fair, efficient, and timely process for appealing decisions about health care payment or services.
If Medicare doesn’t cover your ambulance trip, you have a right to appeal. An appeal is a special kind of complaint you make if you disagree with decisions made by Medicare. To file an appeal, carefully review your MSN. It will tell you why your bill wasn’t paid, how long you have to file an appeal, and what appeal steps you can take. If you decide to file an appeal, ask your doctor or provider for any information that might help your case. You should keep a copy of everything you send to Medicare as part of your appeal. If you need help filing an appeal, call 1-800-MEDICARE to get the number for the State Health Insurance Assistance Program in your state.
For more detailed information about appeals and other Medicare rights and protections, visit www.medicare.gov to read or print the booklet “Your Medicare Rights and Protections.” You can also call 1-800-MEDICARE to find out if this booklet is available in print.For information about Medicare and related topics call 1-800-MEDICARE for answers and information 24 hours a day, every day. OR visit www.medicare.gov on the web.
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Which Ambulance Services Are Covered By Medicare
Medicare covers emergency ambulance services to the nearest facility that provides Medicare-covered services. A medical emergency is defined by an urgent need to be transported to
- A hospital or
- A critical access hospital or
- A skilled nursing facility
for medically necessary services when any other means of transportation endangers your health.
Lets look at some examples. If you break your ankle, you can likely be taken to the hospital by car or taxi without endangering your health. So an ambulance ride wouldnt be covered.
What if your local area does not have the facilities you need? Medicare covers transport to the nearest facility that provides the medical services you need.
For example, what if you live in a rural area and your nearest hospital cant treat your emergency condition? Medicare will cover your ambulance ride to the closest appropriate facility. No matter the distance.
Remember: Medicare only covers emergency ambulance trips to the nearest appropriate medical facility. The facility must provide the necessary care you need. If you choose a facility thats farther away, Medicare only pays the costs to take you to the closest facility. You will be responsible for the remaining cost.
Overview And Membership Benefits
How did the AirMedCare Network membership program get started?
Our Network of Providers were among the first air ambulance services to offer a membership program, similar to the ground ambulance and rural fire department programs throughout the United States. The founders knew that for the service to survive in a rural area, they would need other sources of funding besides the traditional fee-for-service billing. Additionally, the founders knew that the service would be costly, and therefore offered a membership program to assist families with the cost and alleviate the financial burden associated.
What is the benefit of membership to you?
Although you do not have to be a member to be transported, membership offers several important benefits:
First, as one of more than 2.6 million members, AirMedCare Network Providers will work on your behalf with your benefits provider to secure payment for your flight, with any uncovered amounts considered to be fully prepaid. As such, members who are transported by AirMedCare Network will not receive a bill for the flight. Importantly, your membership is valid in all of our service areas so you are covered while traveling in those areas. If they determine air medical transport is needed, they will dispatch one of our ambulance providers.
How can a membership be so inexpensive and yet still be able to cover the costs of the flights?
What is included in a member’s insurance, other benefits and third-party responsibility?
Read Also: How To Enroll In Original Medicare
Your Membership Questions Answered:
The truth is, membership fees go into a corporate fund used for lobbying to retain memberships. Memberships are just a money-making scheme.
The truth is, hospitals typically submit their bills to insurance first, before the air medical transport provider does. Therefore, your deductible is already met prior to your air ambulance bill being processed by your insurance carrier, resulting in no deductible payable for your air ambulance transport. Memberships are rarely needed to cover your deductible.
The truth is, air medical transportation is a covered benefit for both Medicare and Medicaid patients. Medicaid patients have no deductible at all. And, if you are a Medicare beneficiary, there are many Medicare-approved and regulated Medigap policies that will cover any small deductible or copay required. Memberships therefore provide little, if any, actual benefit to you, the patient.
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Does Medicare Cover Air Ambulance Transportation
Medicare Part B does cover emergency air ambulance transportation in an airplane or helicopter if your health condition requires immediate and rapid transportation that ground transportation cannot provide.
Medicare Advantage plans also cover air ambulance transportation when medically necessary. The costs and coverage rules may vary depending on your Medicare Advantage plan.
Medicare Advantage plans also include an annual out-of-pocket spending limit, which Original Medicare does not offer.
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Does Medicare Cover Ground Ambulance Transportation
Ground transportation is also covered by Medicare Part B, but only when other transportation options could endanger your health.
Medicare will only cover emergency ambulance services to the nearest appropriate medical facility. If you choose to be transported to a facility that is farther away, Medicare will only cover what it costs to take you to the closest facility that can give you the care you need, and you must pay the rest.
Note: Medicares payment could be different if youre transported by a Critical Access Hospital . Critical Access Hospitals are small facilities that provide outpatient and limited inpatient services to people in rural areas.
How Much Does The Average Ambulance Ride Cost
Ambulances were once funded by local taxes, but thats no longer the case in most areas. Ambulance services can be expensive, especially if you have no insurance.
If you have insurance other than Medicare, your policy will indicate what your out-of-pocket cost will be for an ambulance. This can range from hundreds to thousands of dollars.
If you have Medicare, the cost of an ambulance ride is determined by a combination of factors. These include a base payment plus mileage, and services that are rendered during transport. These services can include basic life support or advanced life support.
Airambulance transport costs can be even higher than ground costs, reaching astronomicalsums in some instances.
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Ambulance Services With Medicare Advantage
Medicare requires that Medicare Advantage plans cover at least the same services as original Medicare. Therefore, Medicare Advantage policies will usually cover ambulance services. However, they may restrict the ambulance companies that a person can use for a nonemergency.
The cost structure may also vary. A person should carefully read their Medicare Advantage plan benefits to ensure that they understand the potential costs of ambulance transportation under their plan.
Does Insurance Always Cover The Cost
Many people who have insurance through their employer, Medicaid or Medicare, or a private travel or health insurance plan don’t think twice about an ambulance bill. They think the insurer pays for it. But you could still end up with a hefty bill even in cases where coverage is provided, given the clauses in health and travel plans such as deductibles and co-insurance.
Air ambulances are not automatically covered. They’re subject to the rules of each insurer.
You should never assume the full costs of air transport will be covered. You may end up paying thousands of dollars out of pocket if you don’t check with your insurer first. The costs of air transport stem from the company used, the services provided, and the travel distance.
Recommended Reading: How Much Does Medicare Part B Cost At Age 65
Does Medicare Cover Air Ambulance Services
There are a variety of situations in which you might need some form of ambulance service. If youre injured in an automobile accident or a serious fall at home, for example, you might need to be rushed to an emergency room. In some cases, though, medical personnel might suggest an air ambulance. Since this is an expensive option, you might hesitate because youre not sure if Medicare coverage extends to air ambulance services.
Medicare Ambulance CoverageWhether you have Original Medicare Part A and Part B or are enrolled in a Medicare Advantage Plan, you may have some coverage for ambulance services. As a general rule, the plans strongly favor ground transportation ambulances because the service costs are substantially lower. That being said, Medicare Part B and Medicare Advantage plans will also cover air ambulance services in some cases.
Medically NecessaryThe defining question in terms of Medicare coverage for air ambulance services is this: Is it medically necessary? Your care must require immediate and rapid ambulance transportation that ground transportation cant provide. Medical necessity can look very different to a doctor than it does to Medicare. An example of medical necessity might be if you require a specialized, complex, time-critical surgery.
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Medicare Coverage of Ambulance Services
Because many of our clients rely on Medicare and have questions about what Medicare will and will not pay for, we have included this information from the Centers for Medicare & Medicate Services. For more information, please contact Medicare directly at 1-800-633-4227.
U.S. Air Ambulance is not responsible for the accuracy of the information provided. We are sharing it with our readers as a service.
Important: The information in this booklet was correct when printed. Changes may have since occurred. For the most up-to-date version, visit www.medicare.gov on the web. Select “Search Tools” and then select “Find a Medicare Publication.” Or, call 1-800-MEDICARE . A customer service representative can tell you if the information has been updated. TTY users should call 1-877-486-2048.
The “Medicare Coverage of Ambulance Services” booklet isn’t a legal document. The official Medicare Program provisions are contained in the relevant laws, regulations and rulings.
This information is for people who are in the Original Medicare Plan.The Original Medicare Plan is a “fee-for-service” plan. This means you are usually charged a fee for each health care service or supply you get. This plan, managed by the Federal Government, is available nationwide. If you are in the Original Medicare Plan, you use your red, white, and blue Medicare card when you get health care.
Read your plan materials or call your benefits administrator for more information.
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Wyoming Requests Medicaid Pay For All Air Ambulance Flights
Wyoming, a state with expansive plains and a sparse population, is working on a plan through the Section 1115 waiver process to have the federal government cover air ambulance transportation through Medicaid for all state residents, regardless of income.
The intent, according to the states public notice, is to eliminate surprise billing of patients, reduce the cost of service, and increase price transparency for consumers.
The proposal would have Wyoming treat the air ambulance industry like a managed public utility. The state would issue competitive bids on a network of air ambulance providers and support them through periodic flat payments, similar to a gym membership, the proposal states. Providers would then recoup the revenue needed to fund the system from the insurance plans and individuals already paying for transports.
The Centers for Medicare and Medicaid Services accepted the application on November 13. The 30-day comment period ends on December 13.
Unique Challenges
The Wyoming Medicaid Air Ambulance Waiver plan is an attempt to address one of the states unique health care challenges. Wyoming is the tenth-largest state geographically, but its population, at 577,737, is smaller than those of 31 of the nations biggest cities.
This system is broken, wrote Gov. Mark Gordan in the application. My constituents are routinely hit with absurdly high surprise bills, and employers are consistently asked to cover escalating costs.
Deep Doubts
The Cost Of Doing Business
Air ambulance advocates say flying intensive care units 24 hours a day is expensive, and few flights are fully reimbursed.
“We seek every efficiency and innovation to keep costs down,” Ward said in email. “However, being ready to deploy our advanced fleet and highly trained clinicians and pilots at a moment’s notice requires substantial investment and high fixed costs. In fact, the average cost to operate one base is $3 million per year.”
As many as 7 of 10 flights are underpaid because Medicare and Medicaid havent updated their rates in years and private insurers often refuse to pay full freight, she said.
“Insurance companies must step up to the plate and do right by their patients and cover the cost of this critical, emergency health care service,” Ward said.
On in-network agreements, the blame game goes both ways with insurers and air ambulance companies arguing the other won’t accept reasonable fees for service.
Each side contends that competing bills in Congress could solve some of the problem.
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Emergency Air Lift To Hospital Could Cost $40000
By Dennis Thompson HealthDay Reporter
TUESDAY, July 2, 2019 — An air ambulance might be your only chance to survive a medical emergency — but a new study reports it’s going to cost you.
The median charge of an air ambulance trip was $39,000 in 2016, about 60% more than the $24,000 charged just four years earlier, researchers found.
That amount is “more than half of the household income for the average American family in 2016,” said lead researcher Ge Bai. She is an associate professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health in Baltimore.
It’s also much more than the median $10,000 it typically costs the company to conduct a helicopter air ambulance flight, said the Association of Air Medical Services .
Why then the big hike in price when a patient or insurer is presented with the bill?
The new research found that helicopter air ambulances tend to charge fees that are five times the base Medicare reimbursement rate, and mileage rates that are seven times the Medicare rate.
Meanwhile, ambulances that use planes or jets charged initial fees that are four times higher and mileage rates nearly 10 times higher than the Medicare rates.
It’s much cheaper to head to the ER by road — in comparison, ground ambulances charged fees that are 1.5 to three times higher than the Medicare rate, the researchers reported.
It can happen to you
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Industry blames high charges on underpayment by Medicare, Medicaid
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Health Affairs
Ambulance Services That Arent Covered
Medicare will not cover ambulance services that are medically unnecessary. And they wont cover transportation further than the nearest appropriate facility. For example, what if you dont need helicopter transport, but take one anyway? Medicare will only cover the costs for ground ambulance. Youll be stuck covering the difference.
Non-emergency or medically unnecessary transport from one facility to another isnt covered either. Even if its to be closer to home or family.
Medicare never covers ambulette services. An ambulette is a wheelchair-accessible van that provides non-emergency transportation.
Medicare also doesnt cover ambulance transportation when you lack access to alternative transportation.
Also Check: What States Have Medicare Advantage Plans
Insurers Score A Win In Texas Air Ambulance Fee Dispute
State law prevails in disputes between insurers and an air ambulance service over reimbursements under the Texas workers compensation system, the states highest court recently ruled.
In Texas Mutual Insurance Co., et al, v. PHI Air Medical Inc., the Texas Supreme Court held that the Texas Workers Compensation Act and Division of Workers Compensation Rules, which require reasonable reimbursement to privately owned air ambulance services, are not preempted by federal law.
In the suit, PHI, like other air ambulance services across the country, had argued the federal Airline Deregulation Act , which contains no reimbursement requirement, preempts state law and therefore insurance carriers were required to pay the full amount of bills charged by air ambulance companies. The ADA, enacted in 1978, deregulated the airline industry, allowing to commercial airlines set competitive rates.
Insurers typically have reimbursed an amount equal to 125% of Medicare reimbursement amount for air ambulance services, according to an analysis of the case written by Robert R. Graves, an Austin-based partner in the law firm Burns Anderson Jury & Brenner L.L.P. The amounts often charged by air ambulance providers are often far above the reimbursement amount allowed under the TWCA, however.
In both instances, the Court said no.
Other States
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