Social Security Number*
Date of Birth
Pick up Address (Apartment Number if applies) or Facility Name
Where the Patient is going? (Address or Facility Name and Doctor’s Names / Suite Number)
For what reason?
What type of Insurance the Patient has?
*Insurance Carriers and Medicare require the Patient’s Social Security Number and Policy Number(s) for identification and to process the claim.
The type of transportation is based on an industry term: “medically necessary” which is further defined below. Our dispatcher may ask:
Can the patient walk?
Is the patient in a wheelchair?
Is the patient bed bound?
Can the patient maintain a sitting position for an extended period of time?
Does the patient need assistance to stand or pivot?
If the patient can walk or is in a wheelchair, transportation other than an ambulance should be utilized. If the patient is bed bound, cannot sit for an extended period or needs assistance to transfer, an ambulance is utilized. In all emergencies, an ambulance is utilized.
No. Call 9-1-1 immediately in case of an emergency. There is no guarantee that MedTrust has an emergency vehicle in your area and any areas in which MedTrust does provide such emergency coverage, ALL calls will still be handled by your local municipality emergency system and forwarded by them to our dispatch.
Basic Life Support
Basic Life Support (BLS) ambulances provide transport to patients who do not require extra support or cardiac monitoring. A BLS ambulance is staffed by two Emergency Medical Technicians (EMTs) who have training in basic emergency medical care such as basic airway management, use of an automated external defibrillator (AED) and basic drug administration. Examples of BLS transports include:
Basic Life Support emergencies such as lower extremity fractures
Transport to dialysis
Advanced Life Support
Advanced Life Support (ALS) ambulances transport patients who need a higher level of care during transport beyond those services provided by a BLS ambulance. The unit is staffed by two paramedics who have over 1,000 hours of education and training and are qualified to render advanced life support to patients such as advanced airway management, drug administration and cardiac monitoring under the direction of a hospital. ALS can be thought of as providing service equivalent to a local 911 agency/fire department ambulance. Patients who typically require ALS transport include:
Medical/surgical patients with a continuous IV
Patients on a cardiac monitor
Patients with potential airway compromise
Any patient deemed to have a potential complication during transport when reported by the sending facility
Life threatening medical emergencies (For example: respiratory distress, stroke, seizure, or chest pains)
Our dispatch is available 24/7 to schedule appointments. The more notice we are given, the better the chances are that you will get the exact time you request.
Transport for a patient who has an appointment to be seen for an ongoing medical problem (e.g., wound care, dialysis, and radiation) is known as a “medical transfer.” A non-emergency medical transport can also occur when a patient requires transport back to his/her residence at the end of a hospitalization. Medical Necessity for all non-emergency transports is required by Medicare, Medicaid and all insurance carriers.
Medicare states non-emergency ambulance transports are considered medically necessary when the patient’s medical condition is such that the use of any other method of transportation (e.g., taxi, private car, wheelchair coach) would be medically contraindicated (e.g., would endanger the patient’s medical condition).
If you meet the medical necessity for an ambulance, MedTrust can transport you for dialysis and as long as Medicare, Medicaid or your insurance carrier gives approval. With Medicaid, this approval is recognized by a Prior Authorization Number. At MedTrust, we understand the needs of dialysis patients, and transport many dialysis patients each week. This is our specialty and we take great pride in providing the best service available to dialysis patients.
Pricing is determined after factoring in a number of variables, such as emergency or non-emergency, ALS or BLS, services required (such as oxygen, IV’s, etc.), as well as distance traveled, etc. Please call us to receive a quote.
If Medicare covers your ambulance trip, it will pay 80% of the Medicare-approved amount after you have met the yearly Part B deductible. You will be responsible for the remaining 20%.
MedTrust must know who the patient is and we require identification such as a driver’s license, social security card or an insurance card to help identify the patient and process the claim.
Please call and talk to one of our billing specialists to discuss payment options as we will try to work with you.
To comply with applicable laws, requests for medical records must be made in writing. In certain cases documentation and signature authorization are needed.
You will get a Medicare Summary Notice (MSN) from the company that processes claims for Medicare.
The notice will tell you why Medicare didn’t pay for your ambulance trip. For instance, if you chose to go to a facility farther than the closest one, you may get this statement on your notice: “Payment for ambulance transportation is allowed only to the closest appropriate facility that can provide the care you need.”
Or, if you used an ambulance to move from one facility to another one closer to home, your notice may state:
“Transportation to a facility to be closer to your home or family isn’t covered.” These are only examples of statements you may see on your MSN Statements, which vary depending on your situation. If you have questions about what Medicare paid, call the phone number on your MSN or 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
According to MedlinePlus, a medical power of attorney gives specific instructions, prepared in advance,
that are intended to direct medical care for an individual if he or she becomes unable to do so in the
*MedlinePlus is a service of the U.S. National Library of Medicine.
According to MedlinePlus, a do not resuscitate order or DNR, is a medical order written by a doctor. It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if breathing stops or if the heart stops beating. A DNR order allows you to choose before an emergency occurs whether you want CPR. It is a decision only about CPR. It does not affect other treatments, such as pain medicine, medicines, or nutrition. The doctor writes the order only after talking about it with the patient (if possible), the proxy, or family.