Medicare has strict guidelines for payment for ambulance transports. Medicare’s definition of emergency means services provided after the sudden onset of a medical condition manifesting itself by acute symptoms of such severity (including severe pain) that the absence of immediate medical attention could reasonably be expected to result in any of the following:
- placing the patient’s health in serious jeopardy
- serious impairment of bodily functions
- serious dysfunction of any bodily organ or part
If deemed medically necessary Medicare only pays 80% of approved charges often leaving a balance of $70 +. If private insurance pays, it is often 60% to 80% of approved charges, resulting in balances after insurance to exceed hundreds of dollars. For example Arkansas Blue Cross benefit for ambulance service is $1,000 per year.