Emergency transport can be an extremely complicated subject, especially when it comes to insurance. Don’t worry; that’s exactly what MASA MTS is here for. Aside from providing trusted coverage, our goal is to help you understand the system, the gaps in your coverage, and important distinctions in terminology. One of the most important distinctions is the difference between emergent and non-emergent transportation.
In the event you need a ground or air ambulance, the professionals who pick you up will assess the situation and your condition. These assessments often inform how insurance companies classify your trip. Below, we explain the different characteristics that help to determine both emergent and non-emergent transportation.
As referenced in the name itself, emergent transport is used in any situation where needs are immediate. One clear indicator of an emergency is if the patient cannot get to a medical facility by any other means other than an ambulance. Usually, emergency transport is provided after the sudden onset of a medical condition. In these situations, acute signs and/or symptoms must manifest in a way that the absence of immediate attention could result in one or more of the following:
- Serious jeopardy to the patient’s health.
- Serious impairment to bodily functions.
- Serious dysfunction of any organ or body part.
Examples: Heart attack, stroke, serious injury from a car accident, and other life-threatening situations.
The biggest difference with non-emergent transport is that the needs of the patient are not immediate. An easy way to identify non-emergent transport is the ability to schedule your trip. While emergency transportation is a reactive response to a developing situation, non-emergent transport can be planned ahead of time. Generally, each trip must be arranged in advance to include dates, times, and pick-up/drop-off locations. The most common non-emergent transports we see are when clients are moved to specialty care centers after being stabilized. Any medical transport trip that does not meet the emergency definition criteria will more than likely be determined non-emergent. This includes:
- Pre-scheduled transport runs.
- Transport to a nursing home or patient’s residence.
- Transport to and from medical treatments, appointments, or End-Stage Renal Disease (ESRD) facilities for scheduled dialysis.
More Examples: Scheduled medical appointments, chemotherapy, physical therapy, picking up prescriptions, surgery, as well as transportation to specialty care or rehab centers.
Coverage for Medical Transportation
Whether your transportation is emergent or non-emergent, the main characteristic that determines whether or not your insurance will cover the trip comes down to “Medical Necessity.” Depending on your specific health plan, you can get both emergent and non-emergent transportation covered if the patient’s condition is such that use of any other method of transportation (such as taxi, private care, wheelchair van, or another type of vehicle) would endanger his or her health.
Unfortunately, the determination of Medical Necessity is a gamble when it comes to ground and helicopter medical transport. For example, you could be having symptoms commonly associated with a heart attack, take an ambulance to the hospital, and get diagnosed with a panic attack or heartburn instead. Even though you felt like your life was in danger, the insurance company may not classify your trip as medically necessary, and you might be responsible for a majority of the ambulance bill.
On the other end of the spectrum, insurance may cover non-emergency transportation if the patient is bed-confined or if the patient’s medical condition is such that transportation by ambulance is medically required whether or not the patient is bed-confined.
Affordable Protection for Emergency Transportation
While the idea of medical necessity is somewhat easy to grasp, its classification can get complicated. This is the crucial juncture where insurance companies often use loopholes to leave you responsible for paying a majority of the bill. However, with MASA MTS, you don’t have to leave your financial future up in the air. We offer two highly dependable memberships to protect you and your finances when an emergency strikes. Our members are shielded from surprise bills and excessive charges in all emergency situations. Regardless of classifications, distinctions, and all other kinds of red tape, we protect you from the excessive costs of emergency transportation. After all, you should never have to worry about money when a life is on the line.