Q. Is the bill for ambulance covered by insurance?

A. In most cases, yes. However, this depends in large part on the type of coverage that the patient has and whether the service is considered “Medically Necessary” by the patient’s insurance carrier.

Q. I pay for ambulance on my tax bill, why do I also get billed when I use the service?

A. Hernando County Fire Rescue’s EMS division is funded through a combination of ad valorem taxes and user fees. To minimize the impact on the entire citizenry of Hernando County, it was decided to impact everyone for the availability of the service, and only the users for actual usage of the service. In this way, the taxes necessary to support the ambulance service can be held to a minimum.

Q. I was recently transported by ambulance and Medicare denied my bill for Medical Necessity. Why did they deny and what are my rights?

A. The Medicare program will only pay for ambulance services that it deems “Medically Necessary”. In all cases, other means of transportation must be contraindicated due to the patient’s condition, regardless of whether other means are available. In simpler words, the patient’s condition must be acute and such that transport by other means would be endanger the patient’s life, limb or bodily organs. Roughly 20 percent of the transports that we perform on an annual basis do not meet these criteria.

A patient has the right to appeal Medicare’s decision. In the event that a patient's bill is rejected, they can file an appeal for reconsideration. Simply obtain all of the information in regards to the service (i.e. ambulance run form, emergency room notes, physician notes, discharge orders, lab results, etc.) and mail them to the Medicare carrier requesting an appeal.

Medicare Links

U.S. Dept. of Health & Human Services: Centers for Medicare and Medicaid Services

Medicare Benefit Policy Manual
Chapter 10 - Ambulance Services

Medicare as Secondary payer
when
No-Fault & Liability Insurance is available as the primary payer