The MA SMP Program strongly encourages Medicare and Medicaid beneficiaries to know and understand their ambulance coverage BEFORE a situation arises which requires an ambulance. Lack of knowledge can result in unexpected bills in the thousands of dollars.
Remember:
- Medicare only pays for ambulance transportation when there is a medical necessity.
- Medicare will typically pay for an ambulance when it is the only safe way to get you to the nearest appropriate medical facility for EMERGENCY care.
- Medicare may pay for ambulance transportation from one facility to another when a different level of care is necessary.
- End Stage Renal Disease (ESRD) patients may qualify to be taken to dialysis by ambulance. Your doctor and the facility usually make these arrangements.
- You may be asked to sign an Advance Beneficiary Notice (ABN) because Medicare may not pay for the ambulance service, and you may be billed. You are encouraged to ask questions before signing documents and when possible, be sure to keep a record of your answers.
- You always have the right to appeal a service that is not covered by Medicare. You are encouraged to file an appeal if you feel the service should be covered.
- Medicare NEVER pays for chair car service.
How Medicare Handles Ambulance Claims
To address the many complexities related to ambulance billing the MA SMP Program convened a task force. Click here to learn more about the MA SMP Ambulance Task Force.
For the latest information on what Medicare does and does not cover click here to download the MA SMP Program’s ambulance brochure.
See below for a video on how to protect yourself from ambulance fraud.
If you suspect errors, fraud, or abuse, contact the MA SMP Program at 800-892-0890.
