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Unfortunately, Medicare does not always cover ambulance charges to the hospital. It is important to remember that Medicare is a benefit, not an insurance plan. Medicare determines whether an ambulance trip is medically necessary by an established set of guidelines. If it is deemed not medically necessary by these guidelines Medicare will not cover the ambulance trip. Many factors contribute to this decision by Medicare. Some of these factors include:
•Did the patient’s condition at the time 911 was called warrant immediate medical attention? Remember, this decision is made by Medicare, not by the EMS staff attending to the patient.
•Could the patient have been taken to the hospital by any other means of transportation other than an ambulance?
•If the patient was being transferred from one hospital to another hospital by ambulance, could the patient receive the same level of care from the transferring hospital? Also, in many cases Medicare will not pay for transport from a greater facility to a lesser facility, which includes being transported from a hospital back to a residence.
If Medicare does not cover your ambulance bill, you have the right to file with Medicare for a Medical Review. This process is explained in the Medicare Remittance Notice that the patient receives from Medicare in the mail.
When filing for a Medical Review, it is recommended that the patient provide the following documents to Medicare:
•A letter from the patient’s family physician explaining why the ambulance transport was medically necessary.
•Copies of the patient’s ambulance transport medical records. The patient may contact the Great Bend Fire/EMS Billing Office at 620-793-4140 to obtain a copy of his/her records.
•Copies of the patient’s medical records from the hospital that the patient was transported to.
•A letter from the patient explaining why 911 was called for medical assistance. Notice: Filing for Medical Review does not guarantee that Medicare will reverse their original decision, but it is an option available to all patients covered through Medicare.
Most patients have insurance coverage secondary to Medicare. However, most of these secondary insurance policies are Medicare Secondary Supplement Policies, such as Blue Cross and Blue Shield Plan 65. These secondary insurance coverage plans will only cover balances after Medicare pays their coverage rates. Therefore, if Medicare does not cover the charges, then neither will most of the secondary insurance plans.
If a patient receives a bill for their ambulance transport without insurance being filed, it is most likely because the EMS Billing Office does not have complete insurance information on file for the patient. Please contact the Billing Office at 620-793-4141. This information can also be dropped off at or mailed to:
Great Bend Fire/EMS 1205 Williams Great Bend, KS 67530
Once all insurance information is on file with our billing office, we will gladly file a claim with your insurance provider.