Basic Life Support
Basic Life Support (BLS) ambulances provide transport to patients who do not require extra support or cardiac monitoring. A BLS ambulance is staffed by two Emergency Medical Technicians (EMTs) who have training in basic emergency medical care such as basic airway management, use of an automated external defibrillator (AED) and basic drug administration. Examples of BLS transports include:
• Hospital discharges
• Psychiatric discharges
• Basic Life Support emergencies such as lower extremity fractures
• Interfacility transfers
• Transport to dialysis
• Doctor’s offices
Advanced Life Support
Advanced Life Support (ALS) ambulances transport patients who need a higher level of care during transport above those services provided by a BLS ambulance. The unit is staffed with at least 1 paramedic who has over 1,000 hours of education and training and are qualified to render advanced life support to patients such as advanced airway management, drug administration and cardiac monitoring under the direction of a hospital. ALS can be thought of as providing service equivalent to a local 911 agency/fire department ambulance. Patients who typically require ALS transport include:
• Medical/surgical patients with a continuous IV
• Patients on a cardiac monitor
• Patients with potential airway compromise
• Any patient deemed to have a potential complication during transport when reported by the sending facility
• Life threatening medical emergencies (For example: respiratory distress, stroke, seizure, or chest pains)
Medicare Part B covers ambulance transportation. Non-emergency transports to and from Hospitals (excluding Dr. appts), Dialysis, Nursing Homes, and Beneficiaries’ homes, can be a Medicare covered service, if the transport is medically reasonable and necessary. ***Medicare does NOT cover transportation to Doctor Appointments, Medical Office Buildings, or Diagnostic centers or Wheelchair transports.
Medicare states non-emergency ambulance transports are considered medically necessary when the patient’s medical condition is such that the use of any other method of transportation (e.g., taxi, private car, wheelchair coach) would be medically contraindicated (e.g., would endanger the patient’s medical condition).
The lack of an available alternate mode of transportation (e.g., taxi, bus, personal car) or the inability to drive does not satisfy the medically necessary requirements. Non-emergency ambulance transport for convenience or because another means of transportation is not available is not considered medically necessary, and, therefore not covered.
If Medicare covers your ambulance trip, you pay 20% of the Medicare-approved amount, after you have met the yearly Part B Deductible. In most cases, the ambulance company can’t charge you more than 20% of the Medicare-approved amount and any unmet Part B deductible.
Coverage of ambulance transportation by insurance carriers may vary materially based upon a patient’s individual policy. It is the policy holder’s responsibility to know what their policy covers. Please check with your carrier to verify your coverage. For your convenience, please refer to our Insurance Carrier Links page within our website.
If Medicare covers your ambulance trip, it will pay 80% of the Medicare-approved amount after you have met the yearly Part B deductible.
It is always a good idea to contact your insurance provider to see what type of transportation eligibility you are covered for. If you do require a Prior Authorization and one is not obtained before transport, the balance could become patient’s responsibility. It is the policy holder’s responsibility to know what their policy covers, if the provider is in network, and if there is an authorization required before transport.
Individuals are required to sign the PCR (Patient Care Report) along with any Medicare beneficiary form provided at the time of transport. You are required to provide signatures acknowledging consent for treatment and transportation. With this signature, ABRS is authorized to submit a bill on your behalf, assign benefits to the transportation provider allowing your medical insurance carrier to pay them directly, and acknowledge you have received the transportation provider’s Privacy Practices Notice. We cannot submit a claim to a medical insurance carrier without a signed authorization from the patient or guardian. Failure to provide a signed authorization of the patient may require ABRS to seek payment directly from the patient or guarantor.
Insurance plans may cover medically necessary non-emergency transports, but your insurance carrier will determine whether the ambulance transportation meets its medical necessity criteria. Please check with your insurance carrier to understand the specific requirements for payment of non-emergency transport services. It is the policy holder’s responsibility to know what their policy covers.
You must call your insurance provider first, they will set up transportation for you.
Anthem Medicaid call 1-866-288-3133 https://mss.anthem.com/in/benefits/transportation-services.html
MHS CALL 1-877-647-4848 After you are directed to the member prompt, say “transportation.” You can speak to a live transportation representative between 8 a.m. - 8 p.m. Monday through Friday. Transportation is scheduled through a message system after hours and on weekends. All messages are returned within one day.
MDWISE CALL 1-800-356-1204 and choose the transportation option. You should call MDwise to arrange a ride the same day you call for your appointment.
CARESOURCE CALL 1-800-488-0134 *** Healthy Indiana Plan (HIP) members are not covered for non-emergency transportation.
Please call and talk to one of our billing specialists to discuss payment options as we will try to work with you. Billing's phone number 219-838-1111. Our office is open Monday-Friday 8-5 CST
To comply with applicable laws, requests for medical records must be made in writing. In certain cases, documentation and signature authorization are needed.
You will get a Medicare Summary Notice (MSN) from the company that processes claims for Medicare. The notice will tell you why Medicare didn’t pay for your ambulance trip. If you have questions about what Medicare paid, call the phone number on your MSN or 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.