Ambulance rides – no copay?

My kids have been in 3 ambulance rides within the last 6 months.

My insurance has a $350 copay per ambulance ride according to my summary of benefits.

Kid #1 – ambulance ride following a fall that caused a head gash that needed stitches (paramedics said “you can take him or we can take him it’ll just be an expensive Uber – tbh he’s safe to be transported by you” my insurance was billed, expected copay reflected in my EOB, kid #1 at the time had Medicaid as secondary- Medicaid denied the claim. I called to try and pay my copay & EMS said I didn’t have to since Medicaid was billed and denied that’s between them & I’m not responsible. Ok cool

Kid #2 – ride #1 was following an anaphylactic allergic reaction where EMS had to administer multiple injections and they said she definitely had to go to ER with them. Insurance billed – EOB showed $0. Called EMS company they said they’d check & get back to me – heard back & they said i dont have a balance.

Kid #2 – ride #2 was following an episode of being unresponsive & was immediately transported to ER on O2, on all kinds of monitor, etc. EMS said she’s coming with us you can come with or meet us there. Insurance was billed and again EOB shows $0, again called, EMS said no balance.

So it seems like when EMS/or insurance deems it to be 100% medically necessary my copay is waived? Does it seem like that’s what happening to you guys as well? My summary of benefits says $350 per ambulance ride and there’s no “waived if ….” The way my ER copay is waived if it ends in being admitted.

I asked my coworkers and they’ve been billed for ambulance rides before (exact same plan)

submitted by /u/random8142
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