Medicare, Medicaid and Commercial Insurance

 Medicare: Ambulance transportation is a benefit included under Medicare Part B. Provided the transport meets medical necessity criteria and is a covered service, (Medicare does not pay for non-transport ambulance services or On Scene Care) Medicare will pay 80% of the legislatively regulated fee schedule after any applicable deductibles have been met. The remaining 20% is the patient's responsibility either to be covered by a supplemental insurance or private pay.

State Medicaid: Coverage requirements vary state to state and not all Medicaid benefit plans include coverage for ambulance services. You are responsible for providing your Medicaid information to our office for processing.

Commercial  Insurance:  For  your  convenience  we  will  submit  claims  to  private  insurances  including  Health  and  Auto.  We  can  only  submit  claims  for  which  we  have  complete  information  including  policy  numbers,  claim  submission  address,  and  group  name  and/or  number  (when  applicable).

If  we have  submitted  your claim  to  your  insurance  and  you  are  receiving  this  bill  either  45  days  has  passed  without  a  response  or  payment  from  your  insurance  or  they  have  processed  the  claim  and  a  balance  remains  or  your  insurance  company  has  denied  a  portion  of  the  charges  citing  above  "usual  an  customary  charges".

It  is  important  to  know  that  Ambulance  Services  are  not  regulated  by  " usual  and  customary  charge "  and  you  remain  responsible  for  the  entire  balance. The  rate  structure  utilized  by  your  ambulance  provider  is  not  exorbitant  by  any  means;  their  rates  are  based  on  annual  surveyed  averages  of  ambulance  providers  in  their  geographic  area  and  most  importantly  by  operational  expense  governed  by  the  municipalities  which  own  the  service.

You  can  contact  your  insurance  company  to  see  what  appeal  or  reconsideration  options  you  can  pursue  to  see  if  they  will  make  additional  payment.