The following is a list of questions and answers to the most common concerns. If your question is not listed or you require additional clarification to an answer, please contact our Billing/Scheduling Office during normal business hours.
Q: Will my Insurance carrier cover
transportation costs?
A: Insurance plans may cover medically necessary transportation
depending on your specific insurance carrier's guidelines and
policies. Your insurance carrier will also determine whether or not
transportation is justified as medically necessary according to
their specific criteria. It is important to check with your
insurance provider to understand and comply with all requirements
for authorization and qualification for transportation.
Q: Will PRN bill my Insurance carrier
directly?
A: Yes. PRN will bill your insurance carrier directly but may
require co-pays, deductibles, and/or non-covered service payments at
the time of transport. PRN does accept personal checks and Visa/Mastercard
payments for your convenience. You will be notified before the
transportation is scheduled if a payment will be expected at the
time of transport.
Q: What does Medicare cover?
A: In general, Medicare will cover
medically necessary emergency ambulance transportation to the nearest
appropriate medical facility. Emergency ambulance transportation may
qualify for Medicare coverage if the transport is a result of a sudden
onset of a medical condition manifesting itself by acute symptoms of
sufficient severity such that the absence of immediate medical attention
could reasonably be expected to result in placing the patient’s health
in serious jeopardy, impairment to bodily function, or serious
dysfunction to any bodily organ or part. Medicare requires that
ambulance transportation be medically necessary and reasonable. To be
medically necessary, Medicare requires that the use of any other method
of transportation would be hazardous to the patient’s health, whether or
not any other methods of transportation are available. To be
reasonable, for example, Medicare requires the patient to be transported
to the nearest appropriate facility for treatment.
Certain medically necessary non-emergency ambulance transports are covered by Medicare; however wheelchair transportation is not a covered benefit under the Medicare program. Qualifying non emergency ambulance transportation will require a medical necessity form to be filled out and signed by your physician stating the specific reason(s) ambulance transportation is necessary and that transportation by any other means would pose a hazard to the patient’s health.
If Medicare approves the charges, they will pay 80% of the allowable rate. The remaining 20% will be your responsibility if there is no payment made from a secondary insurance source.
Q: What does Medicaid cover?
A:
Generally, Medicaid will cover medically
necessary transportation services for qualifying individuals.
However, like all insurance carriers, there are different policies
that have different requirements so it is recommended you check with
your Medicaid program to better understand coverage for
transportation services. Most Medicaid programs will not cover
transportation for the convenience of the patient and/or family and
will only cover transportation for medical appointments.
Q: How does PRN determine fees and
rates?
A:
Transportation costs typically include base rate charges, mileage
fees and charges for any additional services or supplies (e.g. extra
attendant, oxygen). We will provide you with a total cost before
the transportation occurs upon request. We will also provide you
with an itemized statement of these charges. Our current rates are
determined by many factors such as the cost of providing the service
and other economic forces. Our current rates are available by
contacting our office.