Does Insurance Cover Ambulance Rides? – Pas Trusted News

Ambulance rides are the source of unexpected medical bills for many Americans, even those with health insurance. A Kaiser Family Foundation report found that 51% of emergency ambulance rides for privately insured individuals included an out-of-network charge that can lead to a surprise medical bill.

Even if you’re transported for an emergency, you will likely pay for a portion of the ambulance ride through a copayment, deductible and coinsurance. You may pay even more if your health insurance company doesn’t contract with the ambulance company.

Does Insurance Cover Ambulance Rides?

Private health insurance companies typically provide at least some coverage for ambulance rides, but it depends on the reason for the transport. Most private health insurance plans cover medically necessary ambulance transport.

“Whether an insurance company will cover an ambulance ride depends on whether the transport was medically necessary or not,” says Ken Perry, an emergency medicine doctor in Charleston, South Carolina.

Even if an ambulance ride is deemed medically necessary, such as following a serious car accident, you may still have to pay a copay, coinsurance and a deductible, says Perry.

A health insurance deductible is the amount you pay out of pocket before your health insurance company pays a portion of your health care expenses. Coinsurance is the percentage of a health insurance bill that you pay after reaching your deductible. The exact coinsurance percentage varies by health insurance plan. For example, you may pay 20% for services and the health plan picks up the other 80%.

“Whether an insurance company will cover an ambulance ride depends on whether the transport was medically necessary or not.”

“The best way to think about medical necessity is if you need care even before you get to the hospital,” says Perry. “Difficulty breathing, chest pain or other life-threatening conditions that require assistance by a paramedic before arriving at the hospital will most likely be covered.”

Health insurance plans normally cover emergency transport to the nearest medical facility that can treat your condition. Plans may also cover non-emergency transports, including:

  • Transport from an out-of-network hospital to the closest in-network hospital when medical services are required.
  • Transport to the closest in-network hospital that provides necessary medical care if the original hospital you were taken to cannot provide adequate care.
  • Transport from a short-term or acute care facility to the closest long-term acute care facility.
  • Transport from a hospital to a rehabilitation facility when additional medical care is required.

Congress passed the No Surprises Act, which went into effect in 2022, as a way to reduce unexpected medical bills for:

  • Emergency services
  • Non-emergency services at in-network facilities
  • Post-emergency stabilization services

But ground ambulance rides aren’t included under the law.

Does Insurance Cover Air Ambulances?

Health insurance companies typically cover air ambulance transport in a medical emergency and will charge in-network rates.

The No Surprises Act requires that people transported by air ambulance for an emergency must be charged at in-network rates, even if the company doesn’t have a contract with the insurer. You’ll pay the deductible, coinsurance and copayment as if any air ambulance provider is in network.

When Does Insurance Not Cover Ambulance Rides?

Health insurance plans don’t always cover ambulance rides in non-emergency situations. Some health plans provide limited coverage for non-emergency transport, such as medically necessary transports but only for in-network ambulance companies.

Instances when a health insurance company may not cover an ambulance ride include:

  • Not getting prior authorizations from the insurer.
  • Not meeting appropriate guidelines for an ambulance ride, such as the ride not being medically necessary.
  • Not using the proper billing and submission guidelines, which is how the insurance company is billed.
  • Transportation not done by a licensed ambulance, such as a ride by car, taxi, bus, gurney van, wheelchair van or minivan.
  • Ambulance ride to a home, residential or custodial facility.

Coverage for ambulance rides varies by health plan, so check with your health insurance company before setting up transport if it’s not an emergency.

How Do Health Insurance Companies Contract with Ambulances?

Health insurance companies contract for payment with ambulance companies in much the same way they have contracts with doctors and hospitals. The contracts make those ambulance providers in-network for the health plan.

The insurance company and the ambulance company agree on payment. The ambulance company bills your insurance company, which pays its part of the bill. You pay your copay, deductible and coinsurance.

Since the insurance company has a contract, in-network providers generally cost less than out-of-network ambulances.

If you get transported by an out-of-network ambulance company, you could pay more for the ground transport if you have a preferred provider organization (PPO) or all of the bill if you have a health maintenance organization (HMO).

You can’t always choose which ambulance company arrives on scene, particularly if the ambulance is dispatched by a 911 operator. That means you may get stuck paying more even though you don’t have a choice.

How Much Does an Ambulance Ride Cost?

The average ambulance ride ranges from $940 to $1,277 depending on the level of care needed, according to a 2020 report from FAIR Health. The report found that ambulance charges have increased significantly from 2017 to 2020: Average charges for advanced life support ambulance services jumped about 23%.

The cost of an ambulance ride depends on a few factors, including your location, miles driven and whether the ambulance has advanced life support (ALS) services or basic life support (BLS) services. Most ambulance companies charge a base fee and an additional fee for the distance traveled.

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A Look Insurance Coverage for Ambulance Rides

Here’s a look at whether various insurance policies will help pay for an ambulance ride.

Does Anthem Cover Ambulance Rides?

Anthem, which provides certain Blue Cross Blue Shield (BCBS) health plans, covers the cost of ambulance rides and the required medical services and supplies to the closest medical facility that can treat the patient.

For non-emergency transports, Anthem will cover:

  • The ambulance company’s base rate.
  • Mileage.
  • Parking.
  • Wait times.

Anthem won’t pay for:

  • Unloaded mileage, which is the distance traveled without a passenger.
  • Transport for a caregiver.
  • Base rate for treatment without transport.
  • Excessive mileage, such as mileage beyond the nearest appropriate facility.

Does Cigna Cover Ambulance Rides?

Cigna health insurance covers:

  • Medically necessary emergency ambulance transport.
  • Ambulance rides for patients who require specialized medical services during transport or who are bed-confined and need to be moved to a different medical facility.
  • Emergency transport for patients awaiting a transplant.

An ambulance ride for a transplants patient is only covered by Cigna when the patient is being transported to a facility that can perform the transplant, when the transplant is urgent or time-sensitive and when alternative transportation cannot be arranged due to urgent circumstances.

Does Kaiser Permanente Cover Ambulance Rides?

Kaiser Permanente health insurance covers:

  • Ambulance rides when you’re experiencing a medical emergency that could cause serious bodily harm or impairment.
  • Non-emergency transport when it’s physician-approved or when your condition requires the use of an ambulance.

Kaiser Permanente doesn’t cover transportation via cars, taxis, gurney vans, wheelchair vans, or other types of transportation that aren’t from a licensed ambulance company.

Does UnitedHealthcare Cover Ambulance Rides?

UnitedHealthcare health insurance plans cover:

  • Emergency ambulance rides by a licensed ambulance company from the location of an illness or injury to the nearest hospital that can provide necessary treatment.
  • Most non-emergency transport between medical facilities.

If you get transported to the hospital from an out-of-network ambulance company in an emergency, the UnitedHealthcare benefit level is equal to your in-network deductible or copayment.

Does Medicare Cover Ambulance Rides?

Medicare Part B (medical insurance) covers ground and air ambulance rides in emergencies. It also provides limited coverage for non-emergency transports with a written order from a doctor.

Does Medicaid Cover Ambulance Rides?

Medicaid pays for emergency ambulance rides by licensed ambulance companies. It also covers non-emergency medical transports when there is an order from a physician.

Does Car Insurance Cover Ambulance Rides?

If you’re injured in an auto accident, car insurance pays for an ambulance ride if you have medical payments (MedPay) coverage or personal injury protection (PIP), which is required in no-fault insurance states. These coverage types reimburse you for medical expenses from a car accident, no matter who was at fault, including the cost of an ambulance ride to the nearest hospital:

  • MedPay reimburses you for ambulance fees, your health insurance deductible and copay, hospital visits and stays, rehabilitation, surgery, X-rays and other health care services.
  • PIP insurance covers health-related expenses associated with a car accident, such as an ambulance ride, medical expenses, lost wages, rehabilitation costs and your health insurance deductible.

If you have MedPay or PIP and health insurance, you’ll likely have to make a claim through your auto insurance first for an ambulance ride after a car accident. Even if your health insurance will cover ambulance rides, your auto insurance is likely “primary” after a car accident, meaning you have to go through your car insurance first. You can then make a claim on your health insurance for any medical bills not covered by your car insurance policy.

If you were not at fault for the car accident and you don’t have MedPay or PIP, you can make a claim against the other driver’s liability car insurance for your ambulance ride and other accident-related expenses.

What If Health Insurance Denies Coverage for an Ambulance Ride?

You can appeal a health insurance denial if you are transported to the hospital in an ambulance and your health insurance won’t cover it.

Here are steps to take to appeal a denial:

  • Contact your insurance company. Find out why your claim was denied. It’s possible that the type of transport you used wasn’t actually covered under your plan or the ambulance company didn’t accurately document your condition.
  • Ask the ambulance company for help. The ambulance company may need to provide the necessary documentation to get your claim approved.
  • Appeal the decision. If the claim is still denied, you can appeal. Insurance companies have appeal rules, including deadlines and how to appeal. The National Association of Insurance Commissioners offers a sample internal appeal letter.
  • Check with the insurance company for an update if you don’t hear back. Insurance companies generally have rules dictating when they must decide on an appeal.
  • File another appeal, possibly a third-party review, if you’re denied. Check with your insurance company about how to request an external review of your claim denial.
  • Contact your state’s department of insurance, attorney general’s office or office of consumer affairs if your claim is still denied. States can help you with an external review of the claim denial.

Even if your claim is approved, you may feel you’re being charged too much, such as the out-of-network rates. In that case, check with your state’s department of insurance, attorney general’s office or office of consumer affairs. Many states have laws that protect people from surprise bills for ground ambulance transports.

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