When we bill your insurance you will receive an EOB or Explanation of Benefit from your insurance carrier. Medical Necessity Form Concierge Service Information To learn more about our Concierge Service click the link below. If you find that you do not meet the medical necessity standards Medicare mandates, you can order a Concierge Transort instead. Click here to view a PCS form and the requirements. In determining medical necessity the patients doctor must certify the findings on a PCS or Physicians Certification Statement. If you are unsure if a non-emergency ambulance tranport will be covered, discuss this with your Case Manager, Discahrge Planner, Doctor, or Nurse and have them obtain prior authorization from your insurance provider prior to ordering the ambulance. If Medicare denies your claim due to not meeting the medical necessity standards, you will become responsbible for the entire amount. The remaining 20 percent will be due from you or the your secondary insurance carrier.You will also be responsible for any unmet deductible that you have. Medicare does not typically pay for discharges home to a personal residence.įor both emergency and non-emergency transportation service, Medicare will pay 80 percent of their allowable rate. Medicare does not pay for wheelchair, stretcher or gurney transportation. Medicare also will not pay for ambulance transportation to a preferred hospital or facility that is not the nearest appropriate facility, or for the convenience of the patient, the family or physician. At minimum the patient must be unable to get out of bed without assistance and unable to walk, unable to sit in a chair or wheelchair, and/or that transportation by any other means would pose a danger to the patient's health. While non-emergency inter-facility ambulance transportation is a Medicare benefit, Medicare will not pay for non-emergency ambulance service unless the patient meets medical necessity standards. Senior Care Membership Plan 2019 Medicare Fee Schedule You can find more information on the Membership Program by clicking on the Senior Care tab below. If you need financial assistance due to cover your copay obligation, you may benefit from our Senior Care 911 Emergency Ambulance Membership Program. You can find your area Medicare Allowable Rates here. You will also be responsible for any unmet deductible that you have. If not, you will be responsible for the 20% remaining as a copay. If you have a secondary insurance, we will bill that for you as well. Medicare will pay 80% of the Medicare Allowable ambulance rates for your area. If you recieve a bill from us and have a question, please call your account representative as soon as possible. This request may look like a bill, however, all we need is your signature. If we were unable to get your signature when you were transported to the hospital, you will receive a request in the mail asking for you to confirm your Medicare information and authorize us to bill Medicare for you. If you feel you are having an emergency and call 911, Medicare will cover the transport. Medicare and Medicare Advantage Plans will cover 911 emergency ambulance transportation to the nearest appropriate medical facility if the transport is a result of a sudden onset of a medical condition that could reasonably be expected to result in placing the patient's health in serious jeopardy. It is important to check with your insurance provider to determine the specific requirements for payment related to non-emergency transportation. Each insurance carrier will determine whether or not the ambulance transportation meets their medical necessity criteria. While most insurance plans may cover non-emergency transports, they all restrict non-emergency services to those situations that meet specific medical necessity standards and are ordered by a physican.

These services may be at the Basic BLS level, at the Paramedic ALS level, or at the Critical Care level depending on the medical need. In addition to 911 emergency ambulance services, Care Ambulance provides comprehensive non-emergency ambulance services to patients who need to be safely transported from one facility to another.

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