Your Guide to Understanding Insurance Billing
This guide is designed to help you understand some of the questions you may have about the ambulance billing process, as you decide if a LifeNet Membership is worth the investment for your household.
WHO IS RESPONSIBLE FOR PAYING THE BILL?
The patient transported, or the legal guardian of the patient, if a minor, is ultimately responsible for all billed charges for ambulance transports.
WHAT IS THE COST OF AN AMBULANCE TRANSPORT?
Your cost for your ambulance transport depends on both the distance you were transported and the level of care you received in the ambulance.
Our medical crew will never deny services due to a patient’s inability to pay. Our crews are trained to focus their attention on providing the highest level of care, rather than the billing aspect of their services.
WHY IS YOUR MILEAGE RATE HIGHER THAN USING A RIDE SHARE COMPANY?
Our mileage rates reflect the costs attributed to the use of an ambulance, which ride share companies do not have. These include costs related to things like medical equipment, maintenance, fuel, depreciation, medical crew staffing and training.
WHAT IF I HAVE MEDICARE?
Medicare Part B only covers ambulance transportation in an emergency or when any other form of transportation would endanger your health. It does not cover non-emergency transportation between home and a doctor’s office, for patient/family convenience, for physician preference or convenience, or for elective use of an ambulance when not medically necessary.
Generally, Medicare will pay for the mileage from the point of origin to the closest most appropriate facility with an available bed within the discharging hospital’s service area. If the destination facility is outside of this service area, Medicare will only pay for transportation to that closest facility. You will probably be responsible for mileage incurred beyond this point.
WHAT IF I HAD A MOTOR VEHICLE ACCIDENT?
If you were involved in a motor vehicle accident (MVA), LifeNet will bill your automobile insurance. Most health insurance plans do not pay for transports related to MVAs unless they have received a letter stating that the driver does not carry a medical payment benefit on their auto policy. This letter is often called a “no med-pay letter” or “declaration page.”
WHAT IF I HAVE PRIVATE INSURANCE?
Insurance coverage varies widely from policy to policy. You should review your insurance policy to understand your ambulance transport benefit. Many patients are responsible for deductibles, co-pays, or co-insurance.
LifeNet will file a claim with your insurance company for the medical transport, but payment in full remains your obligation regardless of how insurance processes your claim. Please contact your insurance company for coverage questions.
WHAT DOES IT MEAN IF MY CLAIM WAS DENIED?
Unfortunately, not all claims filed by LifeNet on your behalf are paid by Medicare or private insurers. Your insurance plan has its own specific criteria for payment of claims. Not all transports meet their criteria, which may result in a denied claim.
For example, some insurance companies only pay for an ambulance transport if the patient is admitted to the hospital. Alternatively, they may apply your ambulance bill towards your annual deductible, making you responsible for the transport bill. For more information, you can consult with either Medicare or your insurance carrier.
LifeNet patient account representatives may be able to help provide additional information for you to appeal an insurance denial. They are very knowledgeable in the procedures for re-filing claims.
WHAT IF I DO NOT HAVE ANY INSURANCE?
As a not-for-profit service, LifeNet depends on fees for services delivered to cover our day-to-day operating costs of providing care to the community 24-hours a day, 365 days a year. If you do not have insurance, or if your claim is denied, LifeNet offers a charity program for individuals who qualify for financial assistance.
If you do not qualify for our charitable assistance program, and you are unable to make payment in full, a payment plan can be arranged to accept reasonable monthly payments.
WHAT IF I HAVE A LIFENET MEMBERSHIP?
As a LifeNet Member with insurance coverage, we will accept your insurance company’s payment as payment in full. Any remaining balance on your account will be waived under your membership discount. If your insurance plan requires you to pay 100% of your bill as part of your deductible, we will apply a 40% membership discount to the balance you owe. If you do not have health insurance, you will receive a 40% discount on billed charges for emergency medical transport.