Ambulance rides, or any other emergency medical transportation, including vehicles equipped for land, air or sea, may be covered by your health plan. Coverage may vary from plan to plan and may be subject to your deductibles and coinsurance. Also, whether your ambulance service provider is considered in network or out of network may also affect your coverage.
There may also be restrictions on whether or not the transportation is deemed medically necessary or not. If the service provided was deemed not medically necessary, or does not meet the definition of medical necessity, you may be responsible for the full amount of the service provided.
If you have received emergency ambulance services and receive a bill, be sure to submit it to your health insurance company to seek payment or reimbursement. Also, there could be a limit, or cap, to what your insurance company may pay. So even if you do have coverage, you may still be responsible for a portion of the bill even after your deductible and coinsurance is paid.
Be sure to read your Medical Policy, usually a booklet or pamphlet that your health insurance provider sends with your policy. If you do not have one, call the Customer Service Number, or many companies have the information online.
Most health insurance will cover part of the emergency ride, but not all of it. You may want to add an accident rider or supplemental accident plan to increase the amount that is covered. The advantage of the supplemental accident is that they will also cover dismemberment and death. Many will also help pay for emergency room visits and broken bones.
Insurance Concierge, M&G Insurance, Lake Oswego Oregon
There are also "Life Flight" plans you can purchase to help cover the deductible and co-insurance which you might pay for an ambulance ride. The deductible is the amount you pay up front, before the insurance company helps pay a portion. Once your deductible is met you will pay a co-insurance amount. That mean you will pay a percent and the insurance company will pay the balance. Most co-insurance is 80/20%, 70/30% of 50/50%.
Example:
Your deductible is 2,500, so you must pay 2,500 of all covered (in network usually) ambulance expenses, before the insurance company would pay out 80% on an 80/20% plan. You would be responsible for 20% of all ambulance bills, after your deductible of 2,500 has been paid out by you. The insurance company would be paying 80% of all in network ambulance costs AFTER you've paid out your 2,500 deductible. Once you meet your max out of pocket (MAX OOP), of in network expenses, the insurance company will pay 100% off all in network expenses. You only need to meet your deductible once in a calendar year, pay co-insurance up to your Max OOP once in a calendar year before the insurance company pays 100% of all expenses (in network). If it's out of network some companies offer separate out of network deductibles/co-insurance/Max OOP's. Some insurance companies do not offer any out of network services which means you pay 100% of ALL out of network costs incurred per calendar year. Be careful when purchasing health insurance to know if your company is a PPO or EPO plan. PPO's usually cover across state lines as long as you use doctors in their nationwide network. EPO's usually only cover in network doctors/hospitals, in state.
The additional accident plan, mentioned by others is a supplemental plan that can be purchased. It usually pays up to a chosen amount (chosen by you) of all covered expenses. It pays out in addition, and is usually not based on what the insurance company pays (their portion after deductible). You can usually purchase up to 15,000 of Accident coverage on these stand alone accident plans, which can be purchased any time during the year; and out side Open Enrollment.
Owner /Agent, Guardian Senior Protection, Dallas Fort Worth Texas
You can certainly find insurance plans that cover not only ground ambulance but air ambulance as well. Different companies are going to have different benefit levels so you would need to find a company that includes the type of ambulance service you would be seeking, different companies are going to charge different premium amounts based on the number of benefits, but as a whole ambulance service is fairly routine and built into most coverages. Standard ground ambulance benefit would be $300 and air ambulance would be closer to $800 annually.
ACA compliant health insurance plans are required to cover ambulance, it is one of the 10 essential health benefits required to meet minimal essential coverage. Medicare also covers ambulance. While the ambulance is covered by most health insurance, it can be subject to deductible and coinsurance or have a copay. An accident and critical illness plan can help cover these costs.
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There may also be restrictions on whether or not the transportation is deemed medically necessary or not. If the service provided was deemed not medically necessary, or does not meet the definition of medical necessity, you may be responsible for the full amount of the service provided.
If you have received emergency ambulance services and receive a bill, be sure to submit it to your health insurance company to seek payment or reimbursement. Also, there could be a limit, or cap, to what your insurance company may pay. So even if you do have coverage, you may still be responsible for a portion of the bill even after your deductible and coinsurance is paid.
Be sure to read your Medical Policy, usually a booklet or pamphlet that your health insurance provider sends with your policy. If you do not have one, call the Customer Service Number, or many companies have the information online.
Example:
Your deductible is 2,500, so you must pay 2,500 of all covered (in network usually) ambulance expenses, before the insurance company would pay out 80% on an 80/20% plan. You would be responsible for 20% of all ambulance bills, after your deductible of 2,500 has been paid out by you. The insurance company would be paying 80% of all in network ambulance costs AFTER you've paid out your 2,500 deductible. Once you meet your max out of pocket (MAX OOP), of in network expenses, the insurance company will pay 100% off all in network expenses. You only need to meet your deductible once in a calendar year, pay co-insurance up to your Max OOP once in a calendar year before the insurance company pays 100% of all expenses (in network). If it's out of network some companies offer separate out of network deductibles/co-insurance/Max OOP's. Some insurance companies do not offer any out of network services which means you pay 100% of ALL out of network costs incurred per calendar year. Be careful when purchasing health insurance to know if your company is a PPO or EPO plan. PPO's usually cover across state lines as long as you use doctors in their nationwide network. EPO's usually only cover in network doctors/hospitals, in state.
The additional accident plan, mentioned by others is a supplemental plan that can be purchased. It usually pays up to a chosen amount (chosen by you) of all covered expenses. It pays out in addition, and is usually not based on what the insurance company pays (their portion after deductible). You can usually purchase up to 15,000 of Accident coverage on these stand alone accident plans, which can be purchased any time during the year; and out side Open Enrollment.