Ambulance Coverage: Do You Need It?

You may not be aware of this, but Medicare in Australia does not cover ambulance services or emergency care. These are some of the types of services that private health insurance covers.

However, private funds are not the only ambulance and emergency service providers available. State governments also have their own ambulance and emergency transportation services for community residents, and the cost of these services depends on the state in which you live. In some states, these services are free, but in others they can be expensive enough to consider adding ambulance coverage to your health insurance policy.

Ambulance coverage can be confusing, especially when you consider that there are four different rules for emergency medical transport services in Australia’s seven states. For example, if you live in QLD, NSW or TAS, ambulance services can be provided through your local government or through the payment you make on your electricity bill. Even still, these states don’t pay 100 percent of ambulance or emergency transportation costs, and you may not be covered at all outside of your home state, another reason to consider adding this service to your health insurance plan.

Of course, there are private health funds that offer 100 percent ambulance coverage, so you never have to worry about the cost of getting to the hospital in an emergency, wherever you are. By comparing health plans, you can find a policy that pays for ambulance services and also meets your other health care needs, a real plus when you consider that the bill for an ambulance can be $130 and up.

Residents of ACT, VIC, SA, NT and WA can purchase affordable ambulance insurance through their local government. However, the requirements to receive reimbursement for the full cost of transportation dictate that the ambulance service is medically necessary. In other words, because of your condition or because of your medical emergency, you cannot be transported to the hospital in any other way if you need immediate medical attention. If your health insurance policy includes ambulance cover, read it carefully so that you know whether there are any restrictions on transport by ambulance and, if so, which ones.

Some health insurance funds automatically provide coverage for ambulances in certain specific policies they offer, so it’s important to compare health insurance plans to see which offer this service in addition to other services you may want to secure. Again, make sure you understand the terms of your ambulance coverage, as many have requirements to only call an ambulance to transport yourself or a loved one to hospital when deemed medically necessary under your health insurer’s terms.

Meeting the “medically necessary” requirement may mean one or more of the following:

• You must be transported by ambulance to the hospital or other approved medical facility to receive immediate medical attention.

• As an already admitted patient, you must be transferred to a separate hospital or institution for certain medical procedures.

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• You have called an ambulance, but before it arrives you immediately received professional care, then ambulance transport will no longer be reimbursed.

• An ambulance has been called, but if you receive immediate professional help in the meantime, transport to the hospital will no longer be reimbursed.

• If an air ambulance is needed, you are covered if permission has been obtained in advance.

Ambulance fees are not payable in the following circumstances:

• When any ambulance costs are already fully covered by private ambulance coverage or a state/territory ambulance plan. However, additional costs can be covered when the existing ambulance plan does not pay for the full amount of the services.

• If you are transported by ambulance from one public hospital or recognized center to another while a patient is in hospital.

• Once you have been discharged from a hospital, you are no longer allowed to collect an ambulance reimbursement for transport.

• When you, as an admitted patient, have to be transported to another hospital for treatment because the receiving hospital does not have the facilities to provide you with proper care. Sometimes the hospital that orders your transfer collects the ambulance bill for you.

• If you are 65 and live in WA, you are eligible for free or subsidized ambulance services. If you qualify for subsidized services, you may be able to claim uncovered costs from Medibank.

• Residents of NSW ACT who already pay an Ambulance Charge as part of your health insurance premium, and you are entitled to State Ambulance Coverage, and if you have a Commonwealth Concession Card you may be exempt from paying the State Ambulance Fee.

It is, of course, best to check with your local or state government to determine exactly what is and what is not covered by the ambulance transport scheme.

Remember, if you choose to purchase ambulance coverage or add it to your existing private health insurance policy, you should compare ambulance coverages to find one with the most comprehensive coverage that fits your budget.