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Frequently Asked Questions

Review our frequently asked questions regarding insurance coverage and other important information. If you need any additional information please feel free to give us a call.

What does my insurance cover?

Ambulance transportation coverage varies from insurance policy to policy. It is important to review your insurance coverage to understand what your policy covers. If your policy does not pay 100% of the allowed charges, you will be required to pay a deductible or co-payment as outlined in your insurance policy.

Frequently Asked Questions

Many insurance policies cover medically necessary emergency and non emergency ambulance transportation to and from the hospital.

MedFleet will submit your claim to your insurance company as a courtesy to our patients, however at no time will we guarantee payment and the ultimate responsibility for the trip balance does remain with the patient.

What if I am uninsured?

If a patient does not have insurance coverage, the bill for services will be due from the patient. MedFleet accepts personal checks, Visa, MasterCard, Discover and American Express. Patients can also make payment by phone by contacting the Billing Department at any of our local numbers, or toll free 1-866-991-9111 select option #2.

What does Medicaid cover?

Medicaid is a program funded by the state that provides medical insurance to assist patients who qualify under the program. Medicaid programs require that all ambulance and other non emergency transportation meet the specific medical necessity criteria established by the state.

Frequently Asked Questions

Each county in the state administers the Medicaid non emergency transportation program individually at this time.
Medical transport for non-medical stretcher, wheelchair and ambulatory (cab) calls are scheduled per county.

What does Medicare cover?

Medicare provides coverage for Advanced Life Support (ALS) and Basic Life Support (BLS) emergency and non-emergency Ambulance transports as well as Specialty Care Transport (SCT) services.

Medicare requires that ambulance transportation be medically necessary and reasonable. Medicare also requires that transport be from a qualified origin and destination. For example, transport to and from a routine doctor’s office is not a covered service regardless of medical necessity or reasonableness. Medicare does not cover stretcher or wheelchair transportation.

Medicare pays 80% of the allowable rate for all covered transports and the remaining 20% is due from the patient or secondary payor. As a courtesy, our Billing Department will submit a claim to the secondary insurance carrier on the patient's behalf but the patient is responsible for assuring timely payment by their secondary insurance carrier.

What does Medicare deem as an emergency?

The Balanced Budget Act defines in section 1861 (v) (1) (k) (ii) an emergency as “…the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably be expected to result in placing the beneficiary’s health in serious jeopardy; serious impairment to bodily functions; or serious dysfunction of any bodily organ or part.” Emergency situations (including, but not limited to, shortness of breath, injuries from a fall etc.) are medically necessary and meet Medicare guidelines for ambulance services and transportation.

What does Medicare deem a medically necessary non-emergency?

Non-emergency ambulance transportation is appropriate for patients who have a medical condition that requires medical observation/monitoring from an attendant or for those who are bed confined, however, the patient’s medical records must support the condition. A patient that is bed confined means that all the following conditions exist: the patient is unable to get up from bed without assistance, the patient is unable to ambulate and the patient is unable to sit in a chair or wheelchair.

If transport is not medically necessary and the patient is not bed confined, the most appropriate transportation is non-medical stretcher or wheelchair. (Reminder: Medicare does not cover these services and payment will be required by the patient.)

Even though a transport may meet medical necessity , it will also need to be deemed reasonable and necessary per Medicare guidelines.

What is reasonable and necessary per Medicare guidelines?

A medically reasonable and necessary ground ambulance transport must meet the following requirements: Due to the beneficiary’s condition, the use of any other method of transportation is contraindicated;

The purpose of the transport is to obtain a Medicare-covered service or to return from obtaining such service. While you must obtain a signed Physician Certification Statement (PCS) for the ambulance transport from the beneficiary’s attending physician in some circumstances, this statement does not, in and of itself, demonstrate that an ambulance transport is medically reasonable and necessary.

The ambulance transport is not covered if some means of transportation other than ambulance could be used without endangering the beneficiary’s health, regardless of whether the other means of transportation is actually available.

A transport must be both Medical Necessary and Reasonable and Necessary under Medicare guidelines