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What You Need to Know about Medicare and Air Ambulance Transport

If you have Medicare coverage, you can get coverage for ambulance transportation to or from the hospital. The coverage also includes skilled nursing facility (SNF) or critical access hospital (CAH). It’s important to remember that Medicare will help you pay for ambulance services but only if other modes of transportation could be harmful for your health. This doesn’t necessarily mean you automatically quality for air ambulance transport either. First, let’s take a look at the medical necessity of availing ambulance transport.

Medical Requirement for Availing Ambulance Transport Under Medicare

Medicare will pay for the cost of emergency ambulance transportation in case of sudden medical emergencies with your health being in serious danger, provided that other modes of transportation like cars and taxi could endanger your health. You can get coverage for ambulance transportation if:

  • You’re unconscious
  • You’re bleeding heavily
  • You’re in shock
  • You require skilled medical treatment throughout the transportation

Requirements to Qualify for Air Ambulance Transport Under Medicare

The above-mentioned examples don’t necessarily qualify you fir air ambulance transport that is covered by Medicare. To be eligible for medical transport by air, your condition must require immediate and fast transportation that cannot be done through ground transportation. Medicare will cover for your expenses only if your condition fulfills the following requirements:

  • Ground transportation can’t easily reach your location
  • Obstacles like heavy traffic, long distances, etc. could prevent you from getting the immediate care that you require if you’re traveling by ground ambulance

There may even be a few but special instances wherein Medicare will cover for the cost of ambulance transport even in non-emergency cases. This is provided in case you have a doctor’s letter stating that your medical condition requires transportation with an ambulance.

Airambulance Coverage Myths

People fly across borders frequently for purposes ranging from recreation to business. One concern that bothers most of these travellers is reaching home safely in case there is a health eventuality. It must be noted that airambulance services can be quite expensive and cost more than $100,000 if you do not have adequate coverage. Yet, people tend to ignore medical flight cost coverage. This happens mainly due to misinformation. Here, we burst a few of such myths.

Airambulance Coverage Comes with Health Insurance Policy

This is the biggest myth that costs most people dearly. While some insurance companies cover a few air ambulance service providers, not all are covered. It is vital that you discuss the kind of coverage that your health insurance policy covers. Look at the coverage both domestically as well as internationally. Also, there is hardly any insurance policy that transfers patients to the hospital of their choice.

Travel Insurance and Air Ambulance Coverage are the Same

There can be nothing which is further from the truth. Travel insurance, unless specifically stated, does not cover air ambulance costs. You might be left to fend for yourself in foreign land where healthcare facilities are not up to your satisfaction. If your travel insurance brings you additional cover for medical flights, go for it. Otherwise, go for an additional cover through another agency.

Coverage for International Air Ambulance is Expensive

There is no truth in this statement. Coverage is often surprisingly cheap and does not cost more than $100-150. You can even get your entire family covered for an amount like that. Memberships are usually annual which means you’ll have to keep renewing it – a small price to pay if you fly frequently. Note that such coverage is available for both national and international travel.

Coverage through Credit Cards is Enough

Does your credit card take you to the nearest appropriate facility only or does it take you to the facility of your choice? Are you expected to make the arrangement for air ambulance? What distance is covered? These are just a few of the questions that you need to ask before solely relying on credit card air evacuation coverage.

If you have more questions regarding airambulance coverage, feel free to ask your questions in the comment section below. We’d love to allay your concerns.

Will Your Air Ambulance Service Help with Insurance?

Imagine being in a situation where your loved one has a serious health condition that necessitates use of an air ambulance service and you are left worrying about the cost of utilizing it. No one would want to be in a situation like this. But what if the air ambulance service that you choose offers to help you with the insurance? Yes, there are air ambulance companies out there that will aid you in getting adequate insurance reimbursements. They even hire qualified personnel for this specific purpose. These experts can even give you an idea whether your claim is likely to be accepted or rejected.

Medical Necessity for Air Ambulance Service

There is no denying that the medical necessity for using air ambulance service needs to be established first. How do you achieve that? Well, frankly speaking, it is not in your hands. The physician treating the patient will determine whether the patient needs air ambulance service or not.

If the treating physician deems the use of air ambulance service a medical necessity, will that mean you will get insurance cover? Well, not always. There is the medical director of the insurance company that comes into picture. It is in the right of the medical director to dispute the claims of medical necessity by the treating doctor. If he or she does so, the insurance cover may be denied. However, if you are in good hands, the air ambulance service may try to pursue the insurance reimbursement until the end.

What if the Efforts of the Air Ambulance Company Fail?

That’s a very unfortunate circumstance but not unheard of. If your insurance provider refuses payment and you do not have an air ambulance membership, you might be asked to pay the amount out of pocket. However, most air ambulance service providers offer discounts in such circumstances. You need to be ready to negotiate hard so that you end up paying the minimum.

Understanding Air Ambulance Transport Bills

You are just recovering from a serious health issue that demanded immediate attention. The matter was so urgent that it warranted an air ambulance transport. Just when you think that the worst is over, you are hit with a huge air ambulance transport bill. You breathe a sigh of relief knowing that you are covered by your insurance. Then, another shocker: the insurance company refuses to foot the entire cost. You suddenly find yourself spending sleepless nights not knowing how to foot such a huge air ambulance transport bill. Don’t worry, there’s still hope for you.

The Air Ambulance Transport Bill could be a “Sticker Shock”

It’s not unheard of in the healthcare industry where the listing prices are kept very high and air ambulance transport industry is no different. The prices are significantly lowered later, depending on the negotiating capacity of the patient. It is not unusual for air ambulance providers to come down to half the listed price. Some even offer flexible payment options.

Insurance companies that have huge number of subscribers are most likely to get huge discounts from air ambulance transport companies. Another factor is payment in cash. If you have the resources, the discount could be great. Also, you stand to gain if the air ambulance transport company is in the network of your insurance provider.

Community-Based Air Ambulance Transport Programs

Is the air ambulance transport company that you chose a part of community-based air ambulance transport program? If it is, then you’re lucky. The price is going to be low and is very likely to be covered by your insurance program. However, some air ambulance transport companies remain out of such community-based programs. These companies usually charge a huge amount which is not always covered by insurance companies. The amount not covered is usually recovered through the patient. If you have been served by one such air ambulance company, you might want to negotiate hard with the air ambulance transport company.

The different states of the United States are also in the process of designing a priority list which will mandate that health care providers give preference to community-based air ambulance transport companies before calling a provider who is out of such network.

The word, "INSURANCE"

Airambulance Insurance Legal Again in Alaska

Alaska, the biggest state in the US is also one of the most thinly populated areas, apart from its rough terrains. Airambulance is often the only reasonable means of transport during emergencies. Most citizens of Alaska always opt for adequate cover through private insurance providers to cover any eventualities that may demand airambulance services. Airlift Northwest’s AirCare insurance program is one of them.

The Airambulance Insurance was Deemed Illegal Earlier

Late last year, AirCare was deemed illegal by the state due to a technicality. The problem arose when there was a change in the insurance company’s ownership. Thanks to Gov. Sean Parnell, the changes have now been made, so that the residents of Alaska can continue to enjoy the security of having airambulance coverage. The Governor had passed the bill specifically to accommodate insurance programs that reduce the “out of pocket” payment burden that people have to face. It was a part of the Affordable Care Act.

What does Airambulance Insurance mean for Alaskans?

Take the example of Lubins family. Their daughter, Ella, 13, had fallen off a horse and suffered life-threatening injuries including a skull fracture. She was immediately taken to Harborview Medical Center in Seattle via airambulance, as the local hospital was not equipped to handle the extent of her injuries. Ella was fortunate to get treatment on time and is now recovering. However, the cost had come up to $82,000. Thanks to the family’s insurance, they only had to pay about $9000.

In essence, airambulance insurance means the difference between bankruptcy and a normal life. The family only pays about $99 for this coverage. More than 3000 people in Alaska have so far opted for AirCare insurance coverage.

Airambulance insurance providers in Alaska also offer coverage to visitors. The coverage costs as little as $80 and runs for about 3 consecutive months.

What if Medicare Doesn’t Cover Your Air Ambulance Cost

If you felt the medical situation warranted the air ambulance trip, yet Medicare refused to cover the charges, you don’t necessarily have to be disheartened. You can still check a few things and appeal Medicare to cover the air ambulance expenses.

Check Your Paperwork and Medicare Summary Notice (MSN)

Medicare gives you the reason for not covering air ambulance trip and there can be two primary reasons for it:

  1. The air ambulance company failed to appropriately document your need for air ambulance transport: In a situation like this, contact the doctor or social worker who was involved in mandating the air ambulance transport. Send this information to the organization that handles your medical bills on behalf of Medicare.
  2. The air ambulance company failed to file appropriate paperwork: You can always ask your air ambulance company to re-file your claim. If this does not yield results, you can then proceed to file an appeal.

If Medicare Still Refuses to Pay, File an Appeal

People who have Medicare have certain rights and one such right is filing an appeal against non-coverage of your air ambulance bills. Here’s a stepwise approach:

Look at MSN and find reason for not covering the air ambulance trip: Apart from the reason, the MSN will also let you know the time by which you need to file the appeal.

  1. Follow the instructions on MSN to file the appeal against non-coverage of air ambulance trip: It will also contain the address to which you need to send the appeal. You must accompany it with a letter stating why your air ambulance trip must be covered.
  2. Get in touch with the doctor who suggested air ambulance services: Attach this information to the MSN before sending it to the designated address.
  3. Keep a copy for yourself: You might need the copy of your appeal as a proof, so make a copy and keep it with you.

You can also get in touch with Medicare at 1-800-MEDICARE or visit www.medicare.gov/appeals.

Does Your Travel Insurance Cover International Air Ambulance Evacuation?

The holiday season is here! This is the time of the year when most people head to exotic locations all over the world. Travel insurance is today part of every individual’s holiday planning. You choose to cover minor risks such as losing your belongings that essentially have no financial consequences. You even buy flight insurance to cover your death incase the airplane crashes within the short duration that you travel in it. But have you thought about international air ambulance evacuation coverage? Missing this vital coverage could result in bankruptcy or at least leave you with a huge financial burden.

Why Purchase International Air Ambulance Evacuation Cover?

The exotic places that you travel to might not have the same standards of medical care that your home country provides. According to one estimate only 5 out of every 100,000 tourists ever need international air ambulance evacuation, but when you consider that over 60 million American citizens travelled abroad last year, the number does not seem so small all of a sudden. The need for international air ambulance evacuation actually seems extremely essential.

International Air Ambulance Evacuation Cover is Not as Expensive as You Imagine

One can buy international air ambulance evacuation cover through travel insurance for about $200 to 300. Seems expensive? Think again. Getting back through a commercial airliner with a nurse to accompany you can alone cost about $25,000. A full fledged international air ambulance evacuation can cost you up to $100,000. Also, keep in mind that Medicare does not cover you outside the United States. When you consider the financial risk, spending additional couple hundred dollars for your own safety and wellbeing does not seem all that expensive. Frequent overseas travelers can avail international air ambulance evacuation cover for roughly the same amount through annual plans. With a little thought and adequate cover, you can enjoy this holiday season without any worries at the back of your mind.

“Medical Necessity” for Air Ambulance Services According to Medicare

Medicare demands that certain criteria are met in order to get coverage for the air ambulance services. The information delineated below has been summarized from what has been published by the Department of Health and Human Services – Centers for Medicare and Medicaid Services. The Department has a few basic coverage requirements, perhaps the most important of these is the one that says, “the service is medically reasonable and necessary.” Here, we try to understand this requirement in greater detail.

Air Ambulance Services Transport Requirements

  • The patient’s medical condition demands rapid and immediate air ambulance services.
  • Air ambulance services are required because ALS or BLS can potentially adversely affect the patient’s health or can be a threat to patient’s survival.
  • The POP or point of pickup is inaccessible through ground transport. This can be especially true in areas such as Alaska and Hawaii.
  • The distance to the closest and medically appropriate facility is so much that it demands travel greater than 30 to 60 minutes via ground transport.
  • The instability of ground transport

Medical Conditions that Justify Air Ambulance Services

The list given below is a broad classification and can be further expanded depending on the location and other aspects.

  • Intracranial bleeding (bleeding inside the skull) that warrants the medical intervention of a neurosurgeon.
  • Shock caused by cardiac arrest (cardiogenic shock)
  • Burns that warrant admission of the patient to a burn unit or burn center
  • Medical condition that warrants treatment in a HOU or hyperbaric oxygen unit.
  • Severe and multiple injuries
  • A trauma that can be a threat to patient’s life

Also, facilities such as critical care, burn care, cardiac care and trauma care might not be available at the facility that the patient is first taken, and can be a reason for utilizing air ambulance services.

Understanding these conditions helps people gauge in advance whether Medicare would cover the cost of air ambulance services or not.

Will My Insurance Cover an Air Ambulance Flight?

During a medical emergency, no one wants to worry about money. However, medical care can be very expensive. Air ambulances typically transport the sickest, most critical patients. Air ambulances are operated by highly-trained personnel. Therefore, the costs for air ambulance transport can be astronomical.

Not all insurance companies will pay for air ambulance transport. With almost no exceptions, they will have strict requirements for payment. Typically a patient would need to be in the middle of a severe medical emergency with no other options for the company to pay. Since such situations most often occur unexpectedly, it would be a smart idea to ask you insurance company ahead of time if they will cover transport by air ambulance.

Also, before you decide on a medical flight company, check out the air ambulance company’s ratings and reviews online.  I would also ensure that the air ambulance company is properly accredited and has the appropriate insurance and licenses.