Understanding Insurance Coverage for Ambulance Transport: What You Need to Know

 

Determining whether your health insurance plan covers ambulance transport can be complex. While most plans cover a significant portion of the cost, coverage varies depending on the plan's specifics. Below are some general guidelines to help you understand what to expect from both Medicare recipients and commercial insurance plan beneficiaries.

 

For Medicare:

Medicare covers 80% of the cost of ambulance transport when deemed medically necessary by a healthcare professional. Criteria for medical necessity include situations that a layperson would perceive as a medical emergency, non-ambulatory patients, and those who cannot sit safely in a wheelchair and require a stretcher.

For more information on Medicare reimbursement, visit the Centers for Medicare and Medicaid Coverage Determination Web Page.

 

For Commercial Insurance:

Reimbursement for ambulance transports covered by commercial insurance providers primarily depends on your specific plan. Like any insured service, ambulance transports are subject to your plan's deductible.

Insurance providers typically reimburse Heart to Heart for a significant percentage of the ambulance transport cost, with the patient responsible for the remaining balance. The reimbursement rate depends on your plan's specifics and the premiums you've paid.

 

If you anticipate needing private ambulance services and are unsure about insurance coverage, we recommend contacting your insurance provider directly.

For any questions about a bill from Heart to Heart, please don't hesitate to contact our billing department.