Insurance and Medical Necessity Requirements

Ambulance charges are usually covered for the following services if:

  • Patient must be bed-confined at the time of the ambulance trip
  • Emergency transportation required (i.e., accident, injury, acute illness)
  • Patient must be restrained
  • Patient is unconscious or in shock
  • Patient requires oxygen or other emergency treatment en route
  • Patient must be immobilized because of a fracture or risk of fracture (stretcher bound)
  • Patient is experiencing severe hemorrhaging
  • Patient can be moved only by stretcher
If the patient is unstable and requires emergency transport, we recommend you call 911.

Ambulance charges for the following are not paid by Medicare or supplemental policies, but will be covered if the patient has Medicaid QMB Extended:

  • Transportation to doctor’s appointments
  • Transportation to be treated by a preferred physician or hospital
  • Transportation to be closer to home or family
Transportation back home is treated separately. If you call for ambulance transportation home, the same qualification standards apply. In some cases, the trip to the hospital is covered, by the return trip is not. Return trips are covered by Medicaid QMB Extended.