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.