In most cases an ambulance is requested in an emergent situation by the patient, a family member or a bystander. However, the hospitals requests ambulance service to transport a patient that requires a higher level of care for services not available at first hospital. Patients requiring monitoring or an IV must be transported by ambulance. Many times private insurance doesn’t pay for the non-emergency transports. As long as a physician signs a certification of medical necessity for the transport, the patient will have no out of pocket expense within 500 mile radius.