Denied Claim(s)

Claims that have been denied typically are denied for one of two reasons:

1) Use of the ambulance was determined by the carrier to not be medically necessary; or

2) ambulance service is not a covered service.

If a claim has been determined to have been not medically necessary, there are some specific things that you can do. Many carriers have a review process in which previously denied claims can be resubmitted, with additional information, for further consideration. This additional information involves obtaining additional medical information from the physician, which is your responsibility, in order to make a determination that the use of an ambulance was medically necessary.

The information must be very specific in nature - a doctor writing a letter stating that "ambulance service was medically necessary" will normally be denied on review. If the claim has been denied as "not medically necessary" because the physician did not submit a Certificate of Medical Necessity (CMN) within the required twenty-one (21) days, there is no appeal process available under federal rules. The patient needs to contact their physician and determine why the physician failure to provide a CMN within the required time frame in accordance with Federal Rules and Regulations.

Appeal Process

As a Medicare Recipient you have the right to file an appeal. For your convenience we have included some of the necessary links to help you file your appeal with Medicare should you decide to do so.

1. Obtain a letter from your personal physician stating why (in detail) it was medical necessary for you to be transported to the hospital by ambulance.

2. Obtain a copy of the EVAC run report.

3. Obtain a copy of your medical records from the hospital. (You must obtain these records yourself and may be required to pay a fee to the hospital) Volusia County Hospitals-Medical Records phone numbers).

4. Complete the Medicare Redetermination Request Form.

5. Mail the above 4 items to:

Medicare Part B - Reviews, P.O. Box 2360, Jacksonville, Fl 32231-0018

Appeal Deadline

In order for Medicare to reconsider your ambulance bill, you should file an appeal within sixty (60) days from the date of EVAC's denial letter. Your appeal should be mailed well in advance of the deadline since Medicare's date of denial determines whether they will consider your case.

If you have any questions please call our EVAC customer service department at (386) 252-4900 or (800) 323-3822 Monday thru Friday 8am to 5pm.