When there’s a serious accident or an urgent health emergency, we all know to call 9-1-1 for Emergency Medical Technicians (EMTs) to arrive on the scene. The ambulance arrives and often will take the patient to a hospital where they will receive further care, but what we often don’t think about is how much these ambulance services might cost us.
Most of us have some form of health insurance, whether provided through an employer or state services, but the question is, does insurance cover ambulance rides?
We’ll answer this question and explain what to expect for ambulance costs in Albuquerque if you have to pay out-of-pocket for those fees.
Understanding Different Insurance Coverage
There are various types of insurance that may cover ambulance services, depending on the nature of the incident.
Auto Insurance
Many people travel in an ambulance after a vehicle collision, and your auto insurance may cover the cost if you meet the following criteria:
- Your need for an ambulance is directly related to you being in a car accident
- You have an auto insurance plan that provides ambulance services, such as medical payment coverage, uninsured or underinsured motorist coverage, or personal injury protection (PIP)
- Your ride in an ambulance is deemed medically necessary, for example, broken bones or neck or back pain.
It’s important to understand what your auto insurance policy does and does not cover, and if you’re unsure, you should reach out to your insurance company and find out.
Health Insurance
Whether or not your health insurance covers a ride in an ambulance depends on the type of insurance and the particular plan that you have. You might have a good plan with your insurance that covers an ambulance, while a friend may have the same insurance company, but a different plan that doesn’t cover it.
While it’s best to check coverage differences before you choose your insurance plan, sometimes we don’t know to look at certain options. This could be because we don’t think we’ll ever need these services, but it is important to know what your insurance does and does not cover.
Most health insurance companies will cover ambulance rides, subject to copays, deductibles, and coinsurance, which all depend on the exact plan you have. Usually, you must meet your annual deductible before your insurance will cover the cost of ambulance services. For example, if your deductible is $3,000 and you’ve only met $2,000 even after the ambulance ride, you likely will have no coverage for the ambulance.
Even if you’ve met your deductible, you may still have to pay a copay or coinsurance. If you’re unsure what your health insurance plan covers, contacting your insurance provider for plan details is the best way to understand your coverage.
Ambulance Coverage Through Medicare
According to a Medicare Coverage of Ambulance Systems booklet from the Centers for Medicare & Medicaid Services, Medicare Part B (medical insurance) covers ambulance services to or from a hospital, critical access hospital, rural emergency hospital, or skilled nursing facility. It’s important to note that this coverage of ambulance services only applies to situations where other transportation could endanger your health. For example, if you have a health condition that restricts you from driving.
Emergency ambulance transportation may be available for sudden medical emergencies, such as if you’ve lost consciousness or are bleeding heavily after a serious car accident, or if you need skilled medical treatment during transportation.
If Medicare covers your ambulance trip, you will generally pay 20% of the Medicare-approved amount after you’ve met the yearly Part B deductible, and in most cases, the ambulance company can’t charge you more than that amount and any unmet Part B deductible. Medicare will only cover ambulance services to the nearest medical facility that can give you the care you need; if there are no local facilities that can meet your needs, Medicare will cover the cost of transportation to the nearest facility outside your local area.
Ambulance Costs Without Insurance
If you’ve suffered an injury or sudden health issue you may need immediate medical care from an ambulance, but what if you don’t have insurance or if you don’t think your insurance plan will cover the cost? The City of Albuquerque lists out their current billing rates for ambulance services provided by the Albuquerque Fire Rescue.
- Basic Life Support (BLS) Emergency: $512
- Advanced Life Support Level 1 – (ALS1) Non-Emergency: $385
- Advanced Life Support Level 1 – (ALS1) Emergency: $607
- Advanced Life Support Level 2 – (ALS2) Emergency: $878
- Specialty Care Transport (SCT): $975
- Patient Evaluation – Emergency Response Without Treatment: $136
There is an additional charge of $12.75 per mile of travel for all services except Patient Evaluation. Albuquerque Fire Rescue will attempt to bill all known insurance for a patient, and if they are unable to determine an insurance provider, if the patient has no insurance, or if insurance denies the claim, the patient may receive a bill. In this instance, the patient then has 30 days from the date of the invoice to pay the bill.
So, to answer the main question, yes, your insurance should cover an ambulance ride, but you might not know how much you may have to pay out of pocket for that service as each plan is different. It’s best to check with your insurance provider and get the details of your specific plan coverage to know what those out-of-pocket costs might be and what your annual deductible is.
If you’ve been in a serious accident or needed ambulance services for a medical emergency, our legal team at Barrera Law Group LLC is here to answer any questions you may have. We have experience handling insurance claims for all types of incidents, and we’ll be happy to provide you with answers and assistance during our initial free consultation.