Medicare Regulations for Hospital Patient Transportation

Medicare, the federal medical program for people older than 65, has built up an extensive array of rules about what the program will pay for, including rules on when ambulance transportation is covered. Generally, Medicare only covers ambulance rides when using an alternative would harm your health; if you assume incorrectly that your ambulance ride is covered, you'll have to pay for it out of your own pocket.

Ambulance Transportation

• If your medical condition is critical, speed of transportation is essential and you can't be taken safely by other means, Medicare will cover emergency ambulance transportation, but judged by its standards for emergencies, not yours. For example, medicare.gov states, the government would consider an ambulance a justified expense if you're in severe pain, bleeding or unconscious; you need oxygen or other skilled medical treatment during transportation; or you have to be restrained to avoid injuring yourself or others.

Air Ambulances

• Medicare will cover airplane or helicopter ambulance transportation if it's an emergency; your health requires immediate, rapid transportation; and ground transport isn't fast enough.

Distance

• Medicare publications say the program only covers ambulance services to the nearest facility that can provide you with the care you need. If you choose a hospital or medical center farther away---because you think you'll get better treatment, for example---Medicare will pay for the cost of taking you to the closest facility, and the rest will come out of your pocket. Ambulance transport between facilities for non-medical reasons, such as nearness to your family, won't be covered either.

Non-Emergency Transportation

• Medicare may pay for non-emergency transportation if you need treatment or diagnosis at a medical facility and using any other form of transportation would pose a health risk. It may also be covered if you're confined to your bed and other forms of travel would be risky. A doctor's statement that you need to travel by ambulance can help prove you're entitled to Medicare funding.

Payment And Non-Payment

• If Medicare decides the trip is justified and you've already paid your deductible for Medicare "Part B" insurance, then Medicare will cover 80 percent of the cost. If Medicare won't pay the full 80 percent, it will send you a message telling you why. The government recommends you read over any refusals to see if the hospital or the ambulance company made paperwork mistakes; if so, hold off paying the bill until it refiles the paperwork. Even if there are no paperwork errors, you have the right to appeal the Medicare decision.