While Medicare is most often associated with covering medical care for seniors, they have a special rule that allows coverage for people who have end-stage renal disease and require dialysis. This coverage does not depend on age.
Some people who need dialysis have difficulty attending all of their scheduled appointments due to transportation issues. This can quickly lead to major health problems, as dialysis is necessary to replace the work of the kidneys. One way to ensure that you're able to attend your appointments is to use non-emergency ambulance transport services. However, there are a few conditions you'll need to be aware of before you make use of it. Read on to find out more about the Medicare rules governing non-emergency ambulance transport to a dialysis clinic.
Does Medicare Cover Non-Emergency Ambulance Transport?
When you need dialysis, Medicare will cover the majority of the cost for non-emergency ambulance transport services. However, there are a few requirements that you'll need to fulfill in order to ensure that your trip is covered.
The first is that you need to receive dialysis at the facility that's closest to you. Hospitals and free-standing dialysis clinics are both considered here — your medical transport provider can assist you in locating the closest one.
The second condition is more important, and it tends to be where people encounter trouble. The trip must be deemed medically necessary, and you'll need a statement from your doctor in order to confirm this. In this case, medical necessity refers to the means of transport and not the dialysis treatment that you'll be receiving at the clinic.
What Determines Medical Necessity?
In order to determine medical necessity, Medicare considers whether or not non-ambulance transport would be medically dangerous for you. Alternate forms of transport can include taxis and paratransit services that have wheelchair lifts on their vans.
There are two factors that set ambulance transport apart from other means of travel. The first is that ambulances can carry stretchers in the back. If you are confined to a bed and are unable to walk or sit in a wheelchair, then this may count as a reason why non-emergency ambulance transport is medically necessary.
The second factor is that ambulances are staffed by trained paramedics, and they're able to respond to any emergency situations that may arise in transit. If you require continuous IV infusion or are on oxygen that must be carefully regulated, this can be another reason why this form of transport is medically necessary.
Unfortunately, Medicare does not take into account the actual existence of alternative transport services when determining medical necessity. This affects many people who live in rural areas that have no access to paratransit services. The determination about medical necessity is made based on whether or not alternate means of transport would be unsafe, not if these means of transport actually exist in your area.
How Do You Find Non-Emergency Ambulance Transport for Dialysis?
The first step is to contact a non-emergency ambulance transport service in your area, tell them when you dialysis appointments are scheduled and ask if they have any openings. Once you've found a service with availability, you'll next need to contact your doctor and ask for a statement saying that this is medically necessary.
While speaking to your doctor, you'll also need to request a full copy of your medical records. The medical transport service will require the statement from your doctor along with your medical records — your medical history lets the paramedics transporting you have a better idea of what complications could potentially arise during transit.
Navigating Medicare's rules about medical necessity can be a hassle, but dialysis treatments are lifesaving. It's important to ensure that you have regular access to them. Work with your doctor and medical transport providers in your area to secure access to the non-emergency medical transport services that you need to make your regularly scheduled dialysis appointments.