Frequently Asked Billing Questions
Q: Why Does STAT EMS Require a Signature Before Treatment and Transport?
STAT EMS will not be able to submit a claim to your medical insurance carrier without a signed authorization from the patient or guardian. Failure to provide a signed authorization will require STAT EMS to seek payment directly from the patient or guarantor.
Q: How is Privately Provided Ambulance Service Different? [top]
A: Unlike certain other public services that are supported by tax revenue, private ambulance services are funded by user fees. Tax payers fund public services such as fire and police protection whether they use those services or not. Private ambulance services are typically not subsidized by tax revenue and rely solely on revenue generated when patients use ambulance transportation services.
Under a private ambulance service system, you only pay for those services when you use them.
Q: Does My Insurance Cover Non-Emergency Services? [top]
A: STAT EMS provides comprehensive non-emergency transportation services to patients who need to be safely transported from one location to another. Insurance plans may cover medically necessary non-emergency transports, but your insurance carrier will determine whether or not ambulance transportation is justified as medically necessary according to their specific criteria.
It is important to check with your insurance provider to understand and comply with all requirements for authorization and qualification for non-emergency transportation.
Q: What Does Medicare Cover? [top]
A: Emergency Ambulance Transportation
In general, Medicare will cover medically necessary ambulance transportation to the nearest appropriate medical facility. Emergency ambulance transportation may qualify for Medicare coverage if the transport is a result of a sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in placing the patient’s health in serious jeopardy, impairment to bodily function, or serious dysfunction to any bodily organ or part. Medicare requires that ambulance transportation be medically necessary and reasonable. To be medically necessary, Medicare requires that the use of any other method of transportation would be hazardous to the patient’s health, whether or not any other methods of transportation are available. To be reasonable, for example, Medicare requires the patient to be transported to the nearest appropriate facility for treatment.
Non-Emergency Ambulance Transportation
Certain medically necessary non-emergency ambulance transports are covered by Medicare, but wheelchair and gurney services are not covered benefits under the Medicare program. Some non-emergency ambulance transports may require a certification of the medical necessity signed by your physician. Medicare will not pay for ambulance transportation to a particular hospital or facility that is not the nearest appropriate facility, or for the convenience of the patient, the family or physician. In general, Medicare will not pay for non-emergency ambulance service unless the patient is unable to get out of bed without assistance, and unable to walk, and unable to sit in a chair or wheelchair, and/or that transportation by any other means would pose a hazard to the patient’s health.
For both emergency and non-emergency transportation service, Medicare will pay 80% of the allowable rate. The remaining 20% will be due from you. If you have secondary insurance coverage, STAT EMS will submit a claim on your behalf as a courtesy, but you are responsible for assuring timely payment by your secondary insurance carrier.
Q: What Does Medicaid Cover? [top]
A: While Medicare is a Federal program for qualified citizens over the age of 65, and for certain qualified disabled citizens, Medicaid is a State program intended to assist medically indigent citizens. Because the Medicaid program is administered by each State, the coverage of medical services, including ambulance transportation, varies from state to state. You should check with your Medicaid program to understand coverage for ambulance transportation. In general, the Medicaid program requires that all ambulance transportation meet certain medical necessity criteria.
Q: What Does Insurance Cover? [top]
A: Insurance coverage varies widely from policy to policy. It is important that you review your insurance coverage to be sure that your policy provides ambulance transportation coverage and understand the limitations and requirements of your coverage. You should be sure to obtain authorization prior to receiving services from STAT EMS if required by your policy. Please contact you insurance carrier if you have questions about your coverage. If your policy does not provide 100% coverage for ambulance transportation, you may be required to pay a deductible or co-payment as directed by your plan. Payment of all deductibles and co-payments are due immediately upon receipt of the bill.
As a courtesy to our patients, STAT EMS will submit a claim to your insurance if you provide your coverage information to us at the time of service. Please be aware that as the policy holder, you are responsible for assuring timely payment by your insurance carrier. If your insurance carrier fails to adjudicate and/or pay your claim within the legally specified time frame which is typically 30 to 45 days from receipt of the claim, STAT EMS will seek payment directly from you.
Q: What If No Coverage Exists? [top]
A: If you don’t have any insurance coverage of any kind, the bill for your STAT EMS services will be due directly from you. Payment is due immediately upon receipt of the bill. STAT EMS will accept your personal check, Visa, MasterCard, Discover and American Express. You may also make payment by phone by contacting STAT EMS’s Patient Business Services at the numbers on the STAT EMS Billing Contacts page.
Q: How Does STAT EMS Set its Fees and Rates? [top]
A: Ambulance provider fees typically include a base charge for the transport, a mileage fee, and charges for any procedures, supplies or medications used. Your bill will provide an itemization of each of these charges incurred in your treatment and transportation.
Ambulance provider rates are determined by many factors such as the cost of providing the service and other economic forces in the community. STAT EMS’s rates are both competitive and they meet all applicable local, state and federal limitations, regulations and approval. STAT EMS’s rates also meet all guidelines supported by the American Ambulance Association.