Covering the Bases

Medicare law and the ambulance fee


 
 

Susan Knight | | Tuesday, March 24, 2009


ANNAPOLIS -- I keep up with the legislation that's introduced in the county, and I read that there was a bill passed by the County Council some time ago to allow the county to collect a fee for county ambulance service by the Fire Department to the hospital. What if Medicare won't pay this fee for me?

You don't need to be concerned about how this new law will affect you, and you won't notice any difference or be refused service if you call 911 for transportation in an emergency situation.

When a third-party insurer, such as an employer group plan, a private insurance or Medicare or Medicaid covers the patient, a claim can be filed with that insurance. In other words, collection of fees will take place behind the scenes, just as your other Medicare claims are currently handled. Ambulance transportation is a Medicare Part B service.

The important thing to remember is that Medicare and Medicaid require that the transport must be a true medical emergency for the claim to be considered.

Medicare law is very specific about when emergency ambulance transportation may be covered. Some examples of conditions which are covered include severe pain, bleeding, shock or unconsciousness. If a patient needs to be restrained to keep from hurting himself or others, or needs oxygen or other skilled medical treatment during the transportation, Medicare or Medicaid also will consider the claim for payment.

The law also has several logical protections for individuals requiring emergency ambulance transportation.

First, if the ambulance arrives at the site it is called to but does not transport an individual to a hospital, the individual will not be required to pay the fee.

Additionally, the county ambulance service may not question a patient about his or her ability to pay the fee at the time the service is requested or provided, and no one will be denied service because of an actual or perceived inability to pay the fee.

The bill also allows for waiver of the fee in the event of severe financial hardship.

Sometimes my outpatient services under Medicare are subject to a co-payment, and sometimes they're not. What's the difference?

Your Medicare Summary Notice (MSN) is your best guide to understanding how Medicare covers your medically necessary services. An MSN will show you which services are subject to a deductible or co-payment. If you have a Medigap or other secondary plan, these charges can be referred to that company for consideration of payment.

Doctor's services, outpatient medical and surgical services and supplies, diagnostic tests, ambulatory surgery center facility fees and durable medical equipment are examples of services that have a co-payment of 20 percent of the Medicare-approved amount. Clinical laboratory services such as blood tests and urinalysis are not subject to a co-payment, and this is probably what you have noted as a difference.

Susan Knight is a senior health insurance consultant. If you have questions about the information in this column, contact the county's Senior Health Insurance Program at the Department of Aging and Disabilities at 410-222-4464 or ship_program@aacounty.org




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