MEDICARE SECTION - Part I

How Ambulance Services are covered: Emergency VS Non-Emergency

"Medicare Part B covers emergency ambulance services and, in limited cases, non-emergency ambulance services. Medicare considers an emergency to be any situation when your health is in serious danger and you cannot be transported safely by other means. If your trip is scheduled when your health is not in immediate danger, it is not considered an emergency."

Part B covers emergency ambulance services if:

• An ambulance is medically necessary, meaning it is the only safe way to transport you
• The reason for your trip is to receive a Medicare-covered service or to return from receiving care
• You are transported to and from certain locations, following Medicare’s coverage guidelines
• And, the transportation supplier meets Medicare ambulance requirements

To be eligible for coverage of non-emergency ambulance services, you must:

• Be confined to your bed (unable to get up from bed without help, unable to walk, and unable to sit in a chair or wheelchair)
• Or, need vital medical services during your trip that are only available in an ambulance, such as administration of medications or monitoring of vital functions

"Medicare may cover unscheduled or irregular non-emergency trips, but if you live in a skilled nursing facility (SNF), a doctor’s written order may be required within 48 hours after the transport. Medicare may also cover scheduled, regular trips if the ambulance supplier receives a written order from your doctor ahead of time stating that transport is medically necessary."

"Medicare never covers ambulette services. An ambulette is a wheelchair-accessible van that provides non-emergency transportation. Medicare also does not cover ambulance transportation just because you lack access to alternative transportation."

"Part B covers medically necessary emergency and non-emergency ambulance services at 80% of the Medicare-approved amount. In most cases, you pay a 20% coinsurance after you meet your Part B deductible ($226 in 2023). All ambulance companies that contract with Medicare must be participating providers."

"Note that if you are receiving SNF care under Part A, most ambulance transportation should be paid for by the SNF. The SNF should not bill Medicare for this service."

NOTE: ARTICLE TAKEN FROM “DEAR MARCI”

MEDICARE SECTION - Part II

UnitedHealthcare and St. Joseph’s Health in Upstate New York

Please be advised that St. Joseph’s Health physicians, homecare and facilities will be out-of-network for all Medicare Advantage (MA) and Dual Special Needs Plan (D-SNP) members starting July 1, 2023.

"We are hopeful an agreement will be in place soon, but not before 7/1. There isn’t any progress to report at this time and no extension is expected. If an agreement is made in short order after 7/1, the contract will likely go retro to 7/1/2023."

"Unfortunately, this is all the information we have to this point, but updates will come as more is known" and letters will go out, from UHC.

"For your members that are in need of continuity of care for existing conditions or upcoming procedures, please have them call into Customer Service to see if they are eligible and they will assist with getting this in place. If your member does not have any appointments for July, we want to continue to ask them for their patience in this manner. UHC is working very hard to get this resolved."

Member options

"UnitedHealthcare remains committed to providing broad access to network providers for our members. Below are just a few providers that will continue to be available for our MA and D-SNP members:"

• Crouse Health Hospital, Inc.
• Upstate University Hospital
• University Hospital Community Campus

Continuity of care

"Some members may be able to continue receiving care at St. Joseph’s Health with in-network coverage for a period of time. These members include, but are not limited to, those who are scheduled for surgery or those undergoing active treatment for a serious medical condition such as cancer.

To determine eligibility, members can call the customer service number on their member ID card. UnitedHealthcare MA and D-SNP members can still visit St. Joseph’s Health in an emergency."

This does not apply to UnitedHealthcare AARP® Medicare Supplement plans which do not require the use of a network.