We’ve already discussed situations where Medicare covers medical flight costs. It must be noted in this regard that the coverage is almost always given only when there is an emergency. What if there is a situation where you feel that you are entitled for medical flight coverage by Medicare but the company that provides medical flight services feels otherwise? This is the question we try and answer here.
Disagreement Pertaining to Medical Flight Need
If the medical flight company believes that your situation warrants its service, it will have no problem carrying you to the desired destination. However, if it feels that you do not need medical flight services, you might be asked to sign Advance Beneficiary Notice of Noncoverage (ABN). If you strongly believe that Medicare will cover the medical flight cost later, you can sign this piece of paper and get well on your way to the desired destination. The medical flight service provider would have no qualms about it. However, there are some aspects you need to keep in mind.
You Might Have to Pay for the Medical Flight in Advance
Signing the ABN also means that you would bear the cost of the medical flight if Medicare does not cover it. The air ambulance company may ask you to pay the costs in advance and ask you to recover it from Medicare later. It is necessary that the company asks you to sign this document as, otherwise, it may be held responsible for the costs incurred (and not you) in case Medicare does not cover the medical flight cost. You will never be asked to sign an ABN when there is an emergency.
If you refuse to sign an ABN, the medical flight service provider might still take you. Even in a circumstance like this, you may have to pay out of pocket if Medicare refuses to cover the medical flight cost.
Death of a loved one is always a sad scenario and the cost of transportation is the last thing that lurks your mind at that point. However, it pays to understand the Medicare coverage for air ambulance flights when there is death. Here, we discuss three possible scenarios and how Medicare treats each of these with respect to cost coverage of air ambulance flights.
Death Prior to Boarding the Air Ambulance Flights
Let’s suppose that decision to transport through air ambulance flights has already been taken. However, the patient dies just before boarding the air ambulance. In this scenario, if the dispatcher still has a “reasonable” opportunity to inform the pilot to abort the air ambulance flight and the aircraft has not taken off (even though it is taxied and is cleared to go), the payment from Medicare would be zero. You can still go ahead with carrying the patient to the desired destination but Medicare does not cover such air ambulance flights.
Death after Air Ambulance Flights Takeoff to Point of Pick-up
Now, we take the scenario where air ambulance flights take off for point of pick-up but the patient dies before loading him or her to the aircraft. In such cases, the air ambulance flights are paid adequate airbase rate without mileage or rural adjustment. A QL modifier will have to be used during the claim in this situation.
Death after the Patient is Loaded to the Air Ambulance Flights
Unfortunately, the patient dies during the flight or upon transfer to the receiving facility. Here, Medicare provides the coverage as if the patient was still alive. The death still does not ensure full coverage. Many a times, people don’t get full coverage of air ambulance flights even if they are alive owing to the nature of care plans.
It must be noted that Medicare coverage of air ambulance flights is very limited. You should further discuss the issue of coverage with your flight coordinator to get a clearer picture beforehand.
Among the many conditions Medicare lays down, ensuring that “the facility is appropriate” is vital. Failing this condition, the medical air transportation service might go uncovered and cause financial stress on you later. Here, we try and understand what makes a medical facility appropriate. The data has been collected from Department of Health and Human Resources, Centers for Medicare and Medicaid Services.
The Medical Air Transportation Must Carry the Patient to an Equipped Facility
The appropriate facility could be an acute care hospital. The facility must be adequately equipped to provide hospital care or skilled nursing services which are in accordance with the demands of the injury or illness that the patient comes with. A physician or specialist who is qualified to take care of the patient must also be available at the destination that the medical air transportation carries him or her to.
Situations that Allow Medical Air Transportation to a More Distant Facility
It is generally assumed that all licensed medical facilities would be able to care for the patient. If the nearest medical facility is not equipped enough to care for the patient, medical air transportation of the patient can be carried out to the next nearest facility. The circumstances that warrant such medical air transportation are as follows:
- The patient’s condition demands a higher level speciality or trauma care, which can only be availed at a medical facility that is more distant.
- There is a problem with the availability of beds in the nearest facility.
The medical air transportation to a facility solely for the purpose of availing the service of a particular doctor is not permissible and might not be covered. Also, Medicare might not cover medical air transportation to a distant hospital merely because the patient desires it, in spite of the medical facilities being available at the nearest hospital.
Unless you are ready to bear the cost of medical air transportation yourself or have other means to cover the cost, these facts must be borne in mind. Knowing such conditions beforehand keeps you insulated from monetary shocks at a later stage.
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.