Tag Archives: Medicare special coverage rule

Medicare’s Special Coverage Rule for Air Ambulance Services

We’ve already discussed several criteria which need to be satisfied for air ambulance services to be covered by Medicare. We also know that an air ambulance service is not covered when you have ground ambulance available. We’ve also discussed the fact that only medical air transportation to the nearest “appropriate” medical facility is covered by Medicare. Well, this is not entirely true. You stand to gain at least part coverage in the above two situations through the Special Coverage Rule. It helps:

  1. People who feel air ambulance services are absolutely warranted contrary to what medical professionals opine
  2. People who are comfortable admitting the patient to the facility of their choice only

Understanding Air Ambulance Services in the Context of Special Coverage Rule

It is important to note here that the coverage is not extended to places that are not acute care facilities. Places such as physician’s office, nursing facility or the patient’s home would be excluded.

You Prefer Air Ambulance over Ground Ambulance: Now let’s suppose that the medical experts feel that an air ambulance is not warranted and the ground ambulance would suffice. In such a case, Medicare would pay an amount that would have afforded you ground ambulance. The rest of the money would have to be born by you. This amount may be small and would only offer a negligible respite.

You Want the Medical Facility of Your Choice: On the other hand, the medical experts might feel that air ambulance services are warranted. Here, you would be required to transfer the patient to the nearest appropriate facility. However, if you decide to transport the patient utilizing air ambulance services to a facility of your choice, which is at a greater distance than the nearest one, the cost of extra distance to reach it (from the nearest facility) would have to be born by you.

Remember, the air ambulance service provider can ask you for documentation, which clearly indicates that air ambulance services are necessary. Failing to produce the document can mean that you have to pay for the services and then claim it from Medicare.