You may not be aware of this, but Medicare in Australia does not cover ambulance services or emergency transport. These are some of the types of services that private health insurance covers.
However, private funds are not the only providers of emergency transportation and ambulance services available. State governments also have their own ambulance and emergency transportation services for community residents, and the costs of these services depend 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 plan.
Ambulance coverage can be confusing, especially when you consider that there are four different rules for emergency medical transport services in the seven states of Australia. If you live in QLD, NSW or TAS, for example, ambulance services may be provided through your local government or through payment you make on your electricity bills. Still, these states don’t pay 100 percent of the costs for ambulance or emergency transportation, and you may not have coverage outside of your home state—another reason to consider adding this service to your health insurance plan.
Of course, there are private health care funds that offer 100 percent ambulance coverage, so you never have to worry about the cost of being transported to the hospital in an emergency, no matter where 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 bonus when you consider that an ambulance bill can run $130 and up.
ACT, VIC, SA, NT and WA residents can purchase affordable ambulance coverage through their local government. However, the requirements to receive benefits for the full cost of transportation dictate that the ambulance service be medically necessary. In other words, due to your condition or as a result of your medical emergency, you cannot be transported to the hospital by any other means if you require immediate medical intervention. If ambulance coverage is included in your health insurance policy, be sure to read it carefully to understand if there are any limitations on ambulance transportation, and if so, what they are.
Some health insurance funds provide ambulance coverage automatically on certain specific policies they offer, so it’s important to compare health insurance plans to see which one provides this service in addition to other services you may want to get. Again, make sure you understand the terms of your ambulance coverage, as many will have requirements to call an ambulance to transport yourself or a loved one to the hospital only when deemed medically necessary according to the terms of your health insurance provider. .
Meeting the “medically necessary” requirement can mean any or all of the following:
• You must be transported to the hospital or other approved medical facility by ambulance for immediate medical attention.
• As an already admitted patient, you must be transferred to a separate hospital or facility for certain medical procedures.
• You have called an ambulance, but received immediate professional attention before it arrived, then ambulance transportation will no longer be covered.
• An ambulance has been called, but in the meantime you receive immediate professional attention, then transportation to the hospital is no longer covered.
• When an air ambulance is required, you are covered when prior approval is obtained.
Ambulance benefits are not payable in the following circumstances:
• When any ambulance expense is already fully covered by private ambulance coverage or a state/territorial ambulance plan. However, excess costs may be covered when the existing ambulance plan does not pay the full amount for services.
• When transferred from a public hospital or approved center to another by ambulance while hospitalized.
• Once you are discharged from a hospital, you will not be able to collect ambulance benefits for transportation.
• When, as an admitted patient, you must be transported to another hospital for treatment because the admitting hospital does not have the facilities to care for you adequately. Sometimes the admitting hospital that arranges your transfer will pick up the ambulance bill for you.
• If you are 65 years old and live in WA, you are eligible for free or subsidized ambulance services. If you are eligible for subsidized services, you may be able to claim any non-covered costs from Medibank.
• NSW ACT residents who already pay an ambulance fee as part of their health insurance premium, and are entitled to state ambulance cover, and if they hold a Commonwealth concession card, may be exempt from paying the state ambulance fee.
Of course, it’s best to check with your state or local government to find out exactly what is and isn’t covered by your ambulance transportation plan.
Remember, if you choose to purchase ambulance coverage or add it to your existing private health care plan, compare ambulance coverages to find one with the most comprehensive coverage that fits your budget.
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