Frequently Asked Questions
Disclosure: The information is for informational purposes only
Does Medicare cover my ambulance charges?
Please refer to pages 5 & 6 of the document at: https://www.medicare.gov/Pubs/pdf/11021-Medicare-Coverage-of-Ambulance-Services.pdf
Does Medicare cover the ambulance if I am not transported?
Medicare only covers ambulance charges when a beneficiary is transported. If you were not transported, a claim will not be submitted to Medicare, unless specifically requested for denial by the beneficiary. Limited Exception: Medicare may pay whenever a beneficiary is pronounced dead after the ambulance is dispatched but prior to transport beginning.
How do I know if Medicare didn't pay for my ambulance service?
Please refer to pages 9-10 of the document at: https://www.medicare.gov/Pubs/pdf/11021-Medicare-Coverage-of-Ambulance-Services.pdf
Medicare denied my claim, what options do I have?
Please refer to page 11 of the document at: https://www.medicare.gov/Pubs/pdf/11021-Medicare-Coverage-of-Ambulance-Services.pdf
For additional information about appealing a Medicare Denial please visit:https://www.medicare.gov/claims-and-appeals/file-an-appeal/appeals.html , or call Medicare Beneficiary Line at 1-800-MEDICARE (1-800-633-4227)
Note that you must file your appeal within 120 days of the date you get the Medicare Summary Notice "MSN".
My claim was denied and says "This care may be covered by another payer per coordination of benefits."
If you have Medicare and other health coverage including, but not limited to a group health plan (because you or your spouse is still working), No-fault or liability insurance related to an accident (ex: Car Accident), or Workers' Compensation, there are rules that decide who pays first. Additional information is available in the Centers for Medicare and Medicaid Services publication "Welcome to Medicare & Other Health Benefits: Your Guide to Who Pays First" which can be found by clicking here:https://www.medicare.gov/Pubs/pdf/02179.pdf
Does Medicaid cover ambulance services?
The Medicaid program is administered individually by each State. The coverage of ambulance services varies from state to state. Check with your state Medicaid program to understand your ambulance benefit. Typically, Medicaid programs require that ambulance transportation meet certain medical necessity criteria.
Can I be charged for an ambulance service that is not medically necessary?
Many Medicaid Programs allow medical providers to bill beneficiaries when services are deemed not medically necessary or otherwise not covered, provided they notified the patient in advance of providing the service and the patient signs an acknowledgment agreeing to accept financial responsibility. Where permitted by State regulation/law, this notice may be included in the "Billing Authorization and Privacy Acknowledgment" Form. Otherwise it may be a separate form.
What does Insurance cover?
Insurance coverage varies widely from policy to policy. Review your insurance policy to understand your ambulance benefit, whether they will pay 100% or a lesser percentage of the charges, whether or not deductibles and/or co-pays, co-insurances apply, and any limitations and requirements of your coverage. We do not have access to your specific plan details. Please contact your insurance provider directly with any questions.
Will the ambulance provider file a claim with my insurance?
As a courtesy, we will file the claim if complete insurance information and signature requirements authorizing payment to the ambulance provider are received. Payment in full remains your obligation regardless of how insurance processes a claim. Please contact your insurance company for coverage questions.
How long does it take for my insurance company to pay?
Insurance companies vary on how long it takes to review and pay a claim. We periodically check on claim status, but you will need to contact your insurance company to find out the status of the claim. Payment in full is your responsibility regardless of how your insurance processes.
I received a check from my insurance company, how do I pay my bill?
You need to forward the entire payment to our office, promptly, so your account can be credited.
You can do this one of two ways:
When remitting payment please include a copy of the Explanation of Benefits provided by your insurance company.
Will the ambulance provider accept what my insurance pays as payment in full? My insurance company says I don't owe anything.
Payments received from Medicare, Tricare, Veteran's Administration (VA), Medicaid, and Worker's Compensation Insurance (where required by state law) are accepted as payment in full minus any applicable deductibles, co-pays, or co-insurances.
Most ambulance services are not in-network providers with commercial health insurance companies and therefore do not accept their payment as payment in full. The amount you will have to pay out-of-pocket will vary based on your plan and how they determine their reimbursement rates. Out-of-Pocket expenses include but are not limited to deductibles, co-insurances/co-pays, non-covered charges.
Can I make payments?
Yes, we will be happy to work with you to set up a payment plan. Please call us at (660)-258-2262.
I cannot afford this bill, what do I do?
We will be happy to work with you to set up a payment plan. Contact us for more information.
Patients who request or need emergency ambulance services will never be denied services due to the inability to pay.
What is the definition of Medical Necessity?
Medicare defines Medical Necessity as: "Medical necessity is established when the patient's condition is such that use of any other method of transportation is contraindicated. In any case in which some means of transportation other than an ambulance could be used without endangering the individual's health, whether or not such other transportation is actually available, no payment may be made for ambulance services. In all cases, the appropriate documentation must be kept on file and, upon request, presented to the carrier/intermediary. It is important to note that the presence (or absence) of a physician's order for a transport by ambulance does not necessarily prove (or disprove) whether the transport was medically necessary. The ambulance service must meet all program coverage criteria in order for payment to be made. In addition, the reason for the ambulance transport must be medically necessary. That is, the transport must be to obtain a Medicare covered service, or to return from such a service" Source: Medicare Benefit Policy Manual Chapter 10 – Ambulance Services.
If your ambulance services are denied by Medicare, for not meeting medical necessity requirements, please refer to the Medicare section above under "Medicare denied my claim, what options do I have?" for information on how to appeal the denial.
What is the cost of being treated and/or transported by EMS?
Cost primarily depends on the level of medical services required by the patient, the level of expertise of the responders required to provide that level of care (EMT, Paramedic, etc.). The two most common levels are Advanced Life Support (ALS) or Basic Life Support (BLS). Whether you are/were transported, or just received care at your home, or the scene, can impact the rate you are charged. Being a resident or not a resident of the district served by the Ambulance Service may affect the charge.
How are rates determined?
Rates are determined by the ambulance provider and are based on many factors.
I refused transport, why am I still getting a bill?
The activation of the 911 system and the response of emergency medical personnel incur significant cost even before service is rendered. Receiving an assessment or any care/treatment, regardless of transport, can generate a bill. Each ambulance service independently determines when a charge is assessed, this may include any patient contact even if no vitals were taken or treatment was provided. Please contact us with any questions you may have about you invoice.
I did not call the ambulance why am I being billed for something I did not ask for?
The person for whom the ambulance was requested is the sole individual the ambulance company can legally hold responsible for the charges incurred. An ambulance should be contacted at the earliest point when someone may need emergency medical services. No one should ever hesitate to call 9-1-1 when they think emergency medical services are needed because of a fear of being charged.
Patients who request or need emergency ambulance services will never be denied services due to the inability to pay.
If you believe someone else should be responsible/liable for the ambulance charges incurred you may explore legal options to pursue reimbursement for these expenses. Examples of this may include but are not limited to an auto accident where you were not found to be at fault, or a fall at a business establishment where you believe your fall was caused by neglect on the part of the business.
I was the victim of a crime and my ambulance bill was the result of injuries sustained as a result of the crime. What should I do?
Please visit the Office for Victims of Crime at the U.S. Department of Justice website at https://www.ovc.gov/map.html.
The Federal Victims of Crime Act (VOCA) provides funds to every state to help support local victim assistance and compensation programs. The map at this website will help you find resources in your immediate area that offer services that may include compensation benefits, including reimbursement for medical services, mental health counseling, lost wages, and other costs incurred as a result of the crime.
The patient has passed away, what do I do with the bill?
Depending on the applicable laws of the state of residence of the deceased, an estate or a surviving spouse may be responsible for the bill. Please contact us for more information.
My bill doesn't match what the EMTs/Paramedics told me, or they didn't tell me there was a cost or what the cost would be?
Patients who request or need emergency ambulance services will never be denied services due to the inability to pay. Therefore EMTs and Paramedics are trained to focus their attention on providing the highest level of care to address your medical condition, rather than the billing associated with the services they are providing.
Why does the ambulance service request/require my signature?
The primary purpose of the Ambulance Billing Authorization Form is to authorize us to submit a claim to your insurance on your behalf. Medicare uses this signature as part of their compliance program against false claims. It also authorizes your insurance company to pay the ambulance directly on your behalf.
The patient is not available to sign, can I sign on their behalf?
Medicare regulations at §424.36 require the beneficiary's own signature on the claim, unless the beneficiary has died or the beneficiary is physically or mentally incapable of signing the claim. The claim may then be signed on his or her behalf by one of the following: (1) The beneficiary's legal guardian. (2) A relative or other person who receives social security or other governmental benefits on the beneficiary's behalf. (3) A relative or other person who arranges for the beneficiary's treatment or exercises other responsibility for his or her affairs. (4) A representative of an agency or institution that did not furnish the services for which payment is claimed but furnished other care, services, or assistance to the beneficiary. There are no provisions for convenience or access and no one may sign on behalf of the patient unless the patient is physically or mentally incapable of signing. Please understand any reasons listed explaining the physical or mental incapability to sign must be supported by the Ambulance Patient Care Report submitted with the Signature Form.
I am not the patient, if I sign this form does it make me financially responsible to pay the ambulance bill?
No. A signature on our form does not override applicable state or federal laws regarding financial responsibility for medical expenses incurred by the patient. Most commonly, only the patient or their legal guardian may be held responsible for payment. Some states also permit a spouse of the patient to be held responsible.
What happens if I refuse to sign the authorization?
If the patient/representative (only applies if the patient is physically or mentally incapable of signing) refuses to provide an authorization signature, then the ambulance provider may not bill Medicare or your insurance, but may bill the patient for the full charge of the ambulance services provided. If, after seeing this bill, the patient/representative decides to have their Medicare or Insurance pay for these services, then a patient/representative signature is required. The ambulance provider will file the claim if the signature is received within the claim filing period.
I only was transported by ambulance one time however I am receiving two bills for that service?
This scenario usually results when the first ambulance dispatched to your emergency recognizes that your condition requires a higher level of care than they can provide. To prevent delays in getting you necessary care, a second ambulance responds with crew that has the ability to provide more advanced care. This crew joins the first ambulance crew and provides the care you need during your transport to the hospital. When this happens there are two separate providers who need to be reimbursed for the ambulance services.
I gave my insurance information to the hospital, why don't you get it from them?
Most ambulance services are either municipal based or privately owned and not directly affiliated with a single hospital or health system. While every effort to obtain this information from the hospital is made, sometimes we must contact you to obtain the information necessary to process your claim.
I gave my insurance to the ambulance crew, how come you don't have it?
Every effort is made to not inconvenience the patient by requesting information that has already been provided. There are several different scenarios that would require us to contact you for the information.
Endorse the back of the check with "Pay To The Order of: Linn County Ambulance Disctrict" & sign OR
Deposit the check into your personal account, and then remit payment to our office