Why Was My Ambulance Insurance Claim Denied?

The purpose of health insurance is to pay for the high costs of necessary treatment, some of which are beyond the ability of most people to pay on their own. Ambulance services are just one of the many costs a medical insurance plan may cover. However, if your insurance company denies an ambulance claim, it can have several valid reasons for doing so, leaving you to cover the full cost on your own.

Availability of Other Transportation

• Your ambulance claim will likely be denied if you used an ambulance when other transportation was available that would not have affected your health. Health insurance policies that cover ambulance services require you to use them only when you have no other safe alternative. This means that if your medical issue doesn't require care en route to a hospital or health-care facility, or if a slower trip would be an inconvenience but not a danger to your health, you will not receive compensation for an ambulance claim.

Access to Closer Hospital

• If you use an ambulance to get to a hospital that is not the closest appropriate facility based on your health needs, your insurance company may refuse to cover the expense. For example, if you are out of the house and experience a medical emergency, but ask to be taken to the hospital closest to your home instead of one closer to the site of your emergency, you may be setting yourself up for claim denial. Insurance policies that require you to use an ambulance only when other transportation is unavailable and only to get to the closest appropriate care facility are common, even among government programs, such as Medicare.

Lack of Coverage

• In some cases, your ambulance claim will result in a denial of coverage from your insurance company because your health insurance policy omits ambulance coverage altogether. This is the case with many low-cost forms of health insurance, such as high-deductible policies. While an ambulance will still respond to your emergency call, you'll be entirely without insurance to cover its costs. The lack of ambulance coverage is one of the financial dangers that low-cost, low coverage health insurance poses.

Getting Answers

• Your insurance company's customer service department should be able to inform you of exactly why your claim was denied, either by including information in the denial notice itself or when you contact the department by email or phone. In some cases, an administrative error can cause a claim denial when you deserve reimbursement, so contacting your insurance company, once your medical emergency is no longer a pressing threat, is a useful step. At the very least you can learn about your coverage limits and avoid another costly mistake in the future.