Will My Insurance Cover an Ambulance Ride to the Hospital?
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The cost of an ambulance ride can potentially be covered by multiple types of insurance policies, including health, auto and even home insurance. Depending on the specifics of your policy and the circumstances surrounding the ambulance use, you may find yourself either fully covered, partially responsible for the costs or bearing the entire expense out of pocket.
Find out which insurance companies cover ambulance rides and what you can do if your carrier denies your claim.
What Type of Insurance Covers Ambulance Rides?
From health insurance to auto insurance or home insurance to even accident insurance, each policy offers varying degrees of support for ambulance services, contingent upon specific conditions and requirements.
Health Insurance for Ambulance Rides
Most Affordable Care Act (ACA) marketplace health insurance plans cover ambulance rides. However, coverage is usually contingent on the transport being medically necessary with the individual being transported being admitted to a medical facility. Additionally, while the ride might be covered, patients can still expect to pay for certain expenses out of pocket, such as a copay, coinsurance or deductible.
Health insurance companies that cover ambulance rides include:
- Anthem: Ambulance service reimbursements are set by a base rate that includes equipment and personnel, with mileage billed separately. Non-Emergency Medical Transport (NEMT) claims require origin and destination details and cover costs like transport rate, additional staff, mileage, wait times and other fees.
- Cigna: Ambulance transport is deemed essential during medical emergencies such as when specialized care is required during transit. For transplant situations, urgency and the receiving facility's capabilities are critical determinants. However, transport solely for clinical trials or outside a transplant program's location isn't considered necessary.
- Kaiser Permanente: Kaiser Permanente covers non-emergency ambulance services when deemed medically necessary by a plan physician and if other means could endanger the patient's health. Emergency ambulance services are covered, with Kaiser Permanente hospitals being preferred destinations.
- UnitedHealthcare: Emergency ground ambulance services are medically necessary when a member urgently needs specialized care at the nearest appropriate hospital, especially if delays could harm their health and life support is required during transit.
Car Insurance for Ambulance Rides
If you are involved in a car accident and need an ambulance, your auto insurance policy may cover the cost if you purchased personal injury protection (PIP) or medical payments coverage. Both types of coverage are available even if you were the at-fault driver.
If another driver is at fault for your injuries, the liability coverage on their auto insurance policy should cover your medical transport costs. If they do not have insurance or do not have enough coverage, then uninsured/underinsured motorist bodily injury coverage should cover the costs if you have it.
Home Insurance for Ambulance Rides
A homeowners insurance policy can cover the cost of an ambulance ride for another person, but not for you or another household member. Specifically, a guest’s ambulance fees should be covered under either the personal liability or medical payments (coverage F) portion of your home insurance policy. Coverage usually tops out at a $5,000 limit for coverage F while personal liability can be $100,000 on the low end.
Accident Insurance for Ambulance Rides
Accident insurance, typically acquired through employers, can help cover ambulance costs but is supplementary to health insurance. If you have accident insurance, your coverage pays you a lump sum rather than the ambulance provider directly.
Does Insurance Cover Air Ambulances?
Your health insurance may cover air ambulances, such as helicopters and planes, and it will largely depend on whether it was medically necessary. For example, someone who was stuck in a remote area that was out of reach for a land-based ambulance would need to be life-flighted via helicopter to the nearest hospital. In this scenario, the air ambulance would likely be medically necessary.
Auto and accident insurance may also pay for air ambulances depending on the available coverage and the circumstances surrounding their need for aid. An example would be someone who is severely injured while driving offroad in the desert, prompting a helicopter to come in and evacuate them. The Medpay portion of their plan could help with the cost of the ride.
Will Public Health Insurance Cover an Ambulance Ride?
Coverage for ambulance rides varies between public health coverages such as Medicare and Medicaid, each with its own set of criteria, from emergency needs to specific medical conditions.
Medicare Part B covers ground ambulance transportation when other modes of transport might jeopardize your health. This coverage extends to when you need services from a hospital, critical access hospital or other medical facility. Additionally, for urgent cases requiring rapid transportation, Medicare might cover medical emergency air transport.
In specific non-emergency situations, Medicare can cover ambulance transportation if there's a doctor's written order proving its medical necessity, like for those with end-stage renal disease needing transport to a dialysis facility.
Medicaid provides coverage for emergency ambulance services by state-licensed providers using approved vehicles. For non-emergency ambulance services, a doctor's statement confirming the need is required.
Which Insurance Pays First?
Which insurance pays for your ambulance ride will depend on the situation. Let’s look at a brief example: someone is involved in an accident caused by another driver and needs to be taken to the ER.
In this scenario, the offending driver’s insurance should pay before anything else. After that, your own car insurance may be the one that pays next. Your health insurance should then cover any remaining costs. Your accident insurance may cover anything beyond that.
Note that this order is not always the case and you should check with your providers if they have rules surrounding which carrier pays first in an accident.
When Won’t Insurance Cover an Ambulance Ride?
If an ambulance ride is not for an emergency, then it is unlikely that your health insurance plan will cover the cost. Coverage is often limited to medically necessary transports from in-network ambulance providers.
It's essential to check with your insurance before arranging non-emergency transport.
Do Health Insurance Companies Contract With Ambulances?
Health insurance companies have contracts with ambulance providers, which puts these providers within the carrier’s network. This setup involves agreed payment terms, where the ambulance bills the insurance and the patient pays any copay, deductible and coinsurance. Using in-network providers is typically cheaper.
However, if you're transported by an out-of-network ambulance, you could pay more, especially with certain insurance plans like PPOs or HMOs. Unfortunately, in emergency situations, patients often don't have a choice in which ambulance company responds, which can lead to higher out-of-pocket expenses.
How Much Are Ambulance Rides?
How much you pay for an ambulance ride will vary depending on your insurance plans and the ride's total cost. For instance, someone with a 20% coinsurance on their healthcare plan will pay toward 20% of the total cost of any ambulance ride, assuming you've already paid your deductible. If you haven't paid your deductible, you must do so before anything is covered by your health insurance.
Other factors influencing the cost of an ambulance ride include:
- Distance and location: The base rate for ambulance services will encompass a specific coverage area. You may be charged more if the ambulance travels outside of this area. Also, remote locations that are difficult to get to may generate higher costs.
- Level of care received: Advanced life support (ALS) services cost more than basic life support (BLS) services. ALS services are provided during emergency situations and include medication administration, advanced monitoring and interventions for stroke and heart attack victims.
- Emergency or non-emergency: Situations that don't require rapid responses or specialized medical training (such as scheduled medical facility transfers) will not cost as much as emergency situations where someone's life is on the line.
- Additional services and equipment: ALS services often require additional hands to help facilitate the patient's needs, leading to higher costs. Also, equipment such as ventilators, defibrillators and cardiac monitors can cause ambulance prices to increase.
- Time of day and demand: The need for emergency medical services (EMS) tends to peak at 10 a.m. and 7 p.m. Receiving ambulatory aid during these times can lead to higher costs.
How Much Does an Ambulance Ride Cost Without Insurance?
You can expect to pay around $1,300 for an ambulance ride depending on the level of severity of your needs.
Will I Get a Surprise Bill for My Ambulance Ride?
You may get a surprise bill from out-of-network providers after an ambulance ride. This refers to an unexpected charge to the patient for medical services they believed were covered by their carrier. In some cases, your insurance company may pay a portion of the cost and the facility will charge you for the remaining balance known as a “balancing bill.”
Note this does not apply to ambulance services from traditional ground vehicles. Also, state law may differ from federal law. The Peterson-Kaiser Family Foundation Health System Tracker shared examples of ambulance ride laws from several states.
Regulation on Ambulance Billing
State-regulated plans must reimburse out-of-network private ground ambulances at 325% of Medicare rates. Patients only pay in-network rates. Private ambulances can't bill beyond in-network cost-sharing. Does not cover publicly-funded fire departments.
Ambulances should first charge insurance. If insurance doesn't pay, the patient can be billed.
Regulations on out-of-network payment disputes include ground ambulances.
Protection against surprise bills for emergencies. Ground ambulances are not specifically mentioned.
Local government and volunteer ambulances can't bill patients. Other ambulances can bill directly.
Ground ambulances can't bill more than in-network rates for specific plans (HMOs, PPOs, EPOs).
What Happens if Health Insurance Denies an Ambulance Ride?
If your health insurance company refuses to cover your ambulance fees, you are allowed to contact them and request a specific reason for why it was denied. It might be due to your plan's specifics or an oversight by the ambulance service in documenting your condition. If the situation calls for it, supply missing documentation that can bolster your claim on why the claim should be approved.
Alternatively, you can appeal a denial within 180 days of being denied. Resources like the National Association of Insurance Commissioners may provide useful tools such as sample appeal letters. If the appeal doesn't work, you can get what's known as an external review. You will have four months to file an external review after receiving your insurance company's decision.