Does Your Insurance Cover an Air Ambulance?
What you need to know about air transfers
Air ambulance coverage may come in handy if you are injured while traveling or if you require medical care due to an emergency or a medical condition that requires specialized care that is not available in your local hospital or health-care services center. It may be used during an emergency or to obtain specialized services.
Air Ambulance coverage may be included in health insurance or travel insurance policies. Air ambulance services and air medical transport are not something we usually think about when we are healthy. It's important to review your travel insurance or healthcare insurance coverage in advance to choose a policy that offers air ambulance coverage with lower out-of-pocket expenses, reasonable deductibles and the co-insurance that works best for you.
What Is an Air Ambulance?
The definition of an air ambulance, also known as a medical air transport, is any form of aircraft equipped with medical supplies, equipment and qualified medical professionals that will provide mobile medical care to a patient during transport to a medical facility specialized in responding to the medical needs of the patient in transport. An air ambulance transports patients to medical facilities when other transportation will not be adequate for them to receive necessary medical care.
An air ambulance may be a helicopter or an airplane; its mission is to ensure the best possible medical care during transport of a patient to a medical center or hospital equipped to best deal with the condition, injury or illness. Air ambulances are largely used in emergency medical situations or situations where timing is of the essence in helping a patient receive treatment. Air ambulance coverage may be covered under a health insurance or travel insurance policy.
They Are Useful...
- When you are injured during a trip and would like to be transported home to receive care near home
- If you need to go to medical facilities for specialized treatment
- If you need to be transported to a rehabilitation center to receive specialized care
- If being transported by ground is impossible or will provide a risk to your health
- When rapid transportation is necessary
How Much Does One Cost?
According to the National Association of Insurance Commissioners (NAIC) an average cost for one air ambulance flight is between $12,000 and $25,000.
When Can It Be Covered by Health or Travel Insurance?
- When the attending physician at an emergency recommends an air ambulance due to the fact that it is medically necessary
- When a patient receives a letter of medical necessity
Definition: Medically Necessary
Medically necessary refers to the medical care required to prevent, diagnose, or treat an illness, injury, condition, or disease according to current medical standards. Medically necessary health care may refer to either services or supplies and must be deemed medically necessary by a medical doctor.
For example, if an air ambulance is deemed medically necessary, and there is no other way for the patient to receive the care, diagnosis or treatment, then it may be covered by a travel or health insurance plan that covers the cost of air ambulances.
When Is It Medically Necessary?
If you have been in a serious accident or you're in a condition where you may not survive an emergency trip in a land ambulance, an air ambulance may be contacted to come directly to you quickly. The air ambulance has medical professionals on board along with a mini-hospital where they can quickly start treating you as you fly to an appropriate medical center.
Who Would Need an Air Ambulance?
Here are some examples of when you may need an air ambulance as a result of an emergency:
- When other forms of medical transportation would be dangerous to your health or would jeopardize the success of a medically required procedure.
- When you are bleeding beyond the control of regular ambulatory services
- When you need oxygen, life support or other medical assistance during transportation that may not be accomplished with regular services
- Air ambulances are often used in cases involving stroke, heart attack, burn care, head injury, spinal cord injury, and transplant
Air transport via an air ambulance is also common when the site of an injury is a remote destination where regular transport may not be easily accessible, or large distances must be traveled quickly.
Is Approval Required Before?
Even if the physician in an emergency recommends an air ambulance, it still has to be approved by your health or travel insurance. A doctor working for your insurance company will review the request and situation and decide if it is medically necessary by the current medical standards. Your insurance company must approve the recommendation for the air ambulance, or you may not be covered.
Does Insurance Cover the Cost?
Many people who have insurance through their employer, a private travel insurance or health insurance plan, Medicaid or Medicare don't think twice about an ambulance bill because they think the insurance company pays for it. Given the clauses in health and travel insurance policies like deductibles and co-insurance, even in cases where coverage is provided, you could still end up with a hefty bill. Air Ambulances are not automatically covered and are subject to the definitions of the situation by each insurance company.
Check Deductible and Co-Insurance Clauses
You should never assume the full costs of an air transport or air ambulance will be covered. If you don't check with your insurance company first, you may end up paying thousands of dollars out of pocket. Costs associated with air ambulances stem from: the air ambulance company used, the services provided by the air ambulance and the travel distance to the hospital.
What Are the Limitations and Exclusions?
The coverage for emergency air transport will vary from state to state and by insurance type and company. You can contact your state insurance commissioner's office to find out more about the insurance coverages available in your area if you are unsure. Some insurance companies specify the specific situations in which coverage may be provided in whole or in part for air transport services. It is important to note that some insurance companies will also limit the type of aircraft covered under the air ambulance coverage. Insurers may also decide to pay only the portion of the cost they deem "reasonably necessary," similar to the way other health insurance coverages work. In cases like this, the remainder of the bill could be at your cost.
How to Make Sure You Have Coverage
Air Ambulance could be covered under your health insurance plan or your travel insurance. Contact your insurance company, employee benefits plan administrator or your insurance agent to see what air ambulance coverage you may have. If you don't feel like the coverage is sufficient, then ask your insurance company if you can add extra coverage to your policy for an air ambulance. You may also check if you are covered under a spouse's health insurance plan, or under domestic partner benefits. In cases like this, you could also look into reducing costs using coordination of benefits. If you still feel like you need more coverage, you may need to reevaluate your insurance needs with another insurance company.
For Emergencies Only?
According to the Association of Air Medical Services, more than 550,000 people use air medical transports per year in the U.S. An air ambulance is a medical transport used in many circumstances. It is not always for unplanned medical emergency services. Very often a service could be considered medically necessary but may not have the immediate urgency we often think of. Care may be required during transport, but the timing of the transport is not always necessary to be on the spot. Often hospitals coordinate to transport patients and can set a schedule to help lower the costs of the medical transport if the services of the air transport are medically necessary but not urgent.
Example of Non-Urgent Medically Necessary Air Transport
Mark is being treated following a skiing accident at XYZ Hospital. Unfortunately, although Mark is temporarily stable, the XYZ Hospital is an emergency care facility with limited resources, Mark needs more tests and specialized treatment. The closest qualified hospital is too far for him to travel by ambulance due to his injuries, so the doctor recommends an air transport to get Mark to the closest hospital center that can provide the additional services without putting Mark's health at further risk. They arrange a transport for the following afternoon since the care is not critically urgent, yet still requires the advanced care that will be available in the air transport, the air ambulance can come the following day.
Is It Covered by Medicare or ACA?
Medicare or the Affordable Care Act (ACA) coverage may pay for essential services like emergency air-transport if no other form of transport is available and if it meets the criteria for being considered medically necessary. It is important to note that this coverage might be subject the deductible and then the co-insurance clause of the plan, so you would end up paying part of the costs out of pocket even if it is covered by insurance.
Advance Beneficiary Notice of Noncoverage (ABN)
If air ambulance services are deemed medically necessary, yet non-urgent, and may not be covered, you may receive “Advance Beneficiary Notice of Noncoverage” (ABN) that will advise you that you will be held responsible for all charges, so you are made aware before taking the service.
Under the Affordable Health Care Act if it is medically necessary, then air transport may be covered under essential services. Mary sustained a serious injury, and to save her life, her doctor recommended medical transport to a hospital nearby that would be able to offer her the emergency treatment she needed. The air ambulance cost $29,000; she had a $5000 deductible and a 30/70 co-insurance clause. Once the air ambulance services were approved, she did not receive the full $29,000 of expenses for the air ambulance, she received $29,000 less her $5000 deductible, less the 30% co-insurance ($7,200), for a total reimbursement of $16,800. Due to the deductible and co-insurance, she paid $12,200 out of pocket.
Where Will It Take You?
Depending on your health coverage, the air ambulance may take you to the nearest medical facility where you can be treated, or if your contract provides a higher level of coverage, it may take you all the way home. It is where it becomes important to fully understand the coverage you have purchased and based on your personal situation and the kinds of activities or destinations you will travel to, you should decide on how much air ambulance coverage you need.
Does Air Ambulance or Medical Air Transport Cover Transport of a Companion, Dependent or Spouse?
Depending on your health insurance or travel insurance coverage, if the air ambulance is covered, then insurance companies will often include coverage for an accompanying family member or necessary companion in the coverage. Make sure to ask your insurance representative about this.
Is a Private Air Ambulance Service a Good Idea?
There are various private air ambulance services available. These services are generally geared towards travelers who would like to be able to fly back to their home doctor or hospital to be treated if they happen to need medical care while away from home. If you choose to use one of the private air ambulance providers, please remember that although they are great services, they may not provide every ambulance need or cover all the costs of any air ambulance service you choose. If you want to arrange your own air ambulance, then you should contact your health insurance provider prior to making any commitment, or you may find that your claim will be denied. Private air ambulance providers usually have an insurance coordination service, so be sure and find out before purchasing a service if they can help you coordinate with your insurance and outline what costs will or will not be covered. Again, the best thing to do is to make sure you ask plenty of questions and read any contracts carefully before committing to an air ambulance service.
Beware of Out-Of-Network
Even if the Air Ambulance is covered, make sure your health insurance coverage will accept the air ambulance service you are using. If the Air Ambulance is "Out-of-network" you may not get reimbursed for the charges, or may only be paid up to a certain amount. Ask your insurance provider about out of network air ambulances and what you should do if you need an air ambulance, or you may be out of pocket for expensive costs. According to the National Association of Insurance Commissioners, this can cost consumers tens of thousands of dollars.