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MEDICAL TRANSPORTATION
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Transportation Guidelines
According to Section 1861(s)(7) of the Social Security Act, Medicare Part B (Supplementary Medical Insurance) covers and pays for ambulance services, to the extent prescribed in regulations, when the use of other methods of transportation would be contraindicated.
For more information, contact the Centers for Medicare & Medicaid Services:
1-800-MEDICARE (1-800-633-4227)
TTY: 1-877-486-2048
www.medicare.gov
Prince William Hospital case management and nursing staff will assist you in making arrangements for transportation. There are several ambulance companies that provide service to hospital patients in Prince William County. (These companies are not owned by the hospital nor does the hospital have a financial interest in any of these companies).
Life Care: 800-772-1907
Loudoun: (703) 435-6060
Physician Transport: (703) 941-7025
Professional: (703) 658-9180
Transcare: 888-262-7744
Emergency Transports
Emergency services are those provided after the sudden onset of a medical condition. The ambulance destination MUST be a hospital. (If you are a Medicare recipient and receive paramedic services and are not taken to a hospital, Medicare will not cover the cost of these ambulance services).
Non-Emergency Transports
All scheduled transportation services are non-emergencies. These are not covered unless your condition severely limits your ability to move on a temporary or a permanent basis. This means you are confined to bed before and after the transportation. (For Medicare purposes, confined to bed means a patient:
| | Requires assistance to change positions while in bed | | | Cannot be moved by any means other than a stretcher - a patient who can be moved by a wheelchair is not considered bedridden) |
Medicare
Medicare provides limited coverage for ambulance services. This is determined by the following:
| | Medical condition of the patient | | | Services provided | | | Destination |
Medicare pays for ambulance transportation that is both reasonable and necessary. An ambulance should be used only if you have a serious health problem. Reasonable and necessary means that your condition is such that moving you by any other means could result in harm to your health.
Medicare pays for trips only in your local area. The ambulance must go to the closest facility that has the equipment to provide the necessary care. Approved destinations are:
| | A hospital | | | A skilled nursing facility | | | Your doctor’s office, ONLY when it is necessary to stop on the way to the hospital | | | A free-standing dialysis center from a skilled nursing facility |
Sometimes Medicare denies an ambulance claim because the information available does not indicate that the transportation was reasonable and necessary for your medical condition. A physician order does not necessarily guarantee coverage. If you think your trip should be covered, you may request a review. The ambulance company may agree to request a review for you, but you may also request a review.
Medicaid
Medicaid requires that all non-emergency transports receive prior approval from Logisticare. You can contact Logisticare at 1-866-679-6330. Case managers and nurses can assist you with this while you are a patient in the hospital.
Other Insurance
Coverage for ambulance services is subject to the terms of your healthcare plan. Some healthcare policies provide coverage only when a designated ambulance company is used. Case managers are available to assist with these arrangements.
For more
information about medical transportation or if you need help with a claim,
contact the Case Management Department at (703) 369-8363.
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