Understanding what constitutes an air ambulance according to Medicare is necessary. The fact ensures that you get into an aircraft that is equipped enough to take care of you or your loved ones. According to “Medicare Benefit Policy Manual,” the air ambulance needs to be equipped and designed such that it can be of use during emergency and nonemergency situations. It is also essential that a US air ambulance or worldwide air ambulance service complies with the State as well as local laws.
Air Ambulance Equipment Requirements According to Medicare
The medical flight must be equipped with linens, stretcher, medical supplies for an emergency, oxygen supplies and equipment, and other vital emergency lifesavers or life-sustenance equipment. It must also contain support equipment such as neck and back boards, inflatable arm and leg splints. The air ambulance must be complete with necessary signage that signifies it is a medical flight. Telecommunication equipment must be present in accordance with the State or local law. In other words, there should be one wireless telephone or two-way voice radio at the minimum.
Adequate Staffing of Air Ambulance According to Medicare
If a basic life support air ambulance is chosen, it must have two people at the minimum with at least one of them being a certified EMT or emergency medical technician. The certification must have been granted by the state or local authority. The person must have legal authorization to operate lifesaving equipment onboard the medical flight. Any advanced life support air ambulance too must be staffed with two people with at least one being an EMT paramedic or EMT intermediate.
Statement of Compliance to be Furnished by Air Ambulance Service Provider
A statement that signifies compliance to norms laid down by Medicare is necessary for reimbursements. Medicare might ask the air ambulance service provider to furnish these at its discretion, although the information might not be asked for with every flight. The documentary evidence must contain letters from State or local authorities such as certificates, permits and licenses to name a few. Although checking for compliance is not a beneficiary’s responsibility, keeping oneself informed always helps.
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.
We have already discussed previously that air ambulance transport can cost up to $100,000 when it involves crossing international borders. Now, add this amount to the medical expenses you incur overseas and your trip can turn out to be a physical and financial nightmare. Your Medicare and Medicaid will not cover you in a foreign country unless you have purchased supplemental coverage. However, they have no provisions to cover for air ambulance transport overseas whatsoever. Most health insurance policies like Aetna and Blue Cross too won’t cover you for air ambulance transport in situations like these, although they do cover emergency care. You might have to first pay out of pocket and ask for reimbursement later.
Look for Options that Cover Air Ambulance Transport Overseas
As a matter of caution, it therefore becomes necessary that people travelling abroad look at options that actually cover air ambulance transport back home. Let’s explore some of these:
- Travel Guard by AIG is one such option. This includes medical evacuation, which means you have medical insurance along with air ambulance transport charges covered through the policy.
- Med Jet Assist is another option. The only requirement here is that you are 150 miles away from your home. The membership allows the patient to fly back to the hospital of choice once medically stable. Med Jet Assist charters air ambulance transport for this purpose.
- Air Med is also an option which gives you the same benefits as Med Jet Assist does. The only difference here is that Air Med owns its own fleet for air ambulance transport.
- Air Ambulance Card is another company that offers similar services as Med Jet Assist and Air Med.
Never Travel Overseas without Air Ambulance Transport Coverage
It is impossible to compensate for the unfortunate hardships you suffer overseas sometimes. However, having adequate air ambulance transport coverage ensures that you get the best medical care in your home country. Often, the exotic locations that you travel have unhygienic and inadequately staffed hospitals. You do not want to be compelled to seek treatment in such conditions. Good air ambulance transport coverage insulates you from such situations. Plus the amount you pay for such coverage is negligible considering the cost of overseas air ambulance transport.
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.
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.