Ambulance use cover – A trap – SA residences

Bookleaf · Veteran Member

A recent incident involving a family member has highlighted a trap for the unwary.
A schoolyard accident at a country school resulted in my granddaughter being admitted to the local hospital and then being referred on to the Adelaide Womens and Childrens hospital (about 300km) for further test/treatment. Travel by road (private car or ambulance) was vetoed by medical staff due to her condition so air ambulance was the only other option available.

This has led to a review of medical and ambulance cover as the trip to Adelaide is/was not covered by any medical benefit/insurance. The approx $3000 charge, yet to be received, will be a bill to be paid.
Why?

Firstly, NO ambulance services are covered by Medicare or the SA State Government.
Secondly, Ambulance services in SA are therefore on a user pays basis. It is not a free service!!. It is like calling for a very special taxis. The ambulance service will always attend and charge/invoice later.
There are 2 basic classes of use (paraphrased from the SA terms and conditions) :-
a) Emergency Transport :- Where a medical professional determines the transport is basically unplanned and is medically necessary in an expedient manner for the welfare of the patient.
b) Non Emergency transport:- Means a pre-arranged booking for ambulance services for a transfer to or from a hospital, nursing home, residence, or other place in order to receive medical treatment and is Clinically Necessary as authorised by an appropriate Health Professional.

So how are the costs covered by an individual?
Either by taking out an ambulance cover insurance policy with the ambulance service or have cover provided as a benefit contained in their private health/hospital/extras cover from an independent health cover provider.

But here lies the trap. Many (but apparently not all) hospital cover/extra packages only provide for Emergency Cover only. They do not provide/cover Non Emergency events.
So in my families case, the patient was taken to the hospital by the mother. Some hours later medical staff determined that treatment in Adelaide was necessary. This is a planned/pre-arranged booking of the ambulance service, so it is not covered by extras cover we all think covers ambulance services.!! Gotcha!

So how can this be alleviated?
a) By taking out the extra ambulance cover insurance direct with SA ambulance
b) By changing health insurance providers to one that does have Non Emergence cover as a part of its policy.

Furthermore, the basic policies for Emergency Transport provided by any policy only covers SA residence if the use in within the SA state border. There is an extra policy fee to extend cover to interstate use.
Likewise, basic Non Emergency cover is an optional extra and also covers events only in SA. An extra fee extends cover to the whole of Australia.

Each State has differing rules covering the ambulance services in their state. Most are much like SA. I believe the Queensland government covers all Queenslanders for all ambulance use Australia wide (lucky them!)

So extend this concept to your own travels as we travel around Australia in our various RVs. Are you covered for what can be many thousands of dollars of ambulance costs if a medical incident occurs?

We now have Extra Plus cover with the SA ambulance service (for Non Emergency use Australia wide) as well as our pre-existing Medical Benefits cover of Emergency transport only.

PeterInSa · Guru

BF re (We now have Extra Plus cover with the SA ambulance service (for Non Emergency use Australia wide) as well as our pre-existing Medical Benefits cover of Emergency transport only.)

And in SA if you have private health fund insurance eg Bupa, my understanding is that you cannot claim against your SA Ambulance Cover and you cannot get a refund, if you have already paid your subs.
This is stated over page on the invoice.....Heading..... Important information for Members.... NO REFUND.

We have Bupa Emergency cover, I just want to know before hand about non emergency transport, rather than being taken in an Ambo and finding out afterwards that someone has decided its a non emergency. (eg Hospital to Hospital transfer)

Peter

-- Edited by PeterInSa on Friday 21st of September 2018 06:59:53 PM

KFT · Guru

Very strange indeed

In NSW if a clinician decides the patient needs to be transferred to another hospital then the requesting hospital is liable for the cost of the transfer.

Got me stuffed why we need any state health depts. Why do we not have a consistent FEDERAL health system for all aussies???

Hetho · Senior Member

Hi Kevin.

I have always been aware of the different state variants.

In WA, we have Australia Wide cover. With HCF; and most insurers, I believe.

But you need to read the fine print.

I had a ambulance trip 2 weeks ago in Cairns and was fully covered by St Johns Ambulance in WA. No cost to me.

I am Happy that I am covered Australia wide. Ask the question of your insurance provider.

If the answer is no; go shopping.

Regards.

Hetho.

DeBe · Guru

My family has been in SA ambulance for 40 years now & its never been free. Recently flown to Adelaide due to heart attack, 6 Stents fitted.

delatite · Veteran Member

It has been like that for as long as I can remember. Unless you are a member of the various Ambulance Services you will be charged. Emergency or not. If you are admitted to a hospital and then require transport you will not pay. It seems your grand-daughter was not formally admitted, therefore the hospital does not pay you do.
The membership of the Ambulance services is not expensive, and everyone should have this cover if your health cover if you have any, does not cover it. Most Health covers will re-imburse you for the cost of it.

villatranquilla · Guru

delatite wrote:
It has been like that for as long as I can remember. Unless you are a member of the various Ambulance Services you will be charged. Emergency or not. If you are admitted to a hospital and then require transport you will not pay. It seems your grand-daughter was not formally admitted, therefore the hospital does not pay you do.
The membership of the Ambulance services is not expensive, and everyone should have this cover if your health cover if you have , does not cover it. Most Health covers will re-imburse you for the cost of it.

Pensioners living in Victorian do not need Ambulance cover and are covered for all emergency transport and inter- public hospital transfers regardless of which state you are temporarily in

-- Edited by villatranquilla on Saturday 22nd of September 2018 04:21:53 PM

Bookleaf · Veteran Member

The point that came home to us was.
""I have private hospital cover with ambulance cover included"" Which may be true but it does not cover ALL ambulance transport.
That is the trap.
And the severity of the trap varies between medical cover providers and between states.

Just a note for perhaps all of us to check our level of cover. We may be in the back off no-where one day and find out there is no cover the hard way.
(we will still get the transport. The bill comes later!)

PeterInSa · Guru

You are involved in a minor accident, your OK, someone calls the ambo's, they check you out even though you say your OK.... Expect a Bill.

emergencylaw.wordpress.com/2014/10/04/paying-for-ambulance-services/

woofta and precious · Senior Member

School yard accident will be covered by their insurance. Any referrals/transfers from point of admission will be covered by government... Correct me if I'm wrong?

Cupie · Guru

Once a pon a time (sounds like the start of a fairy tale .. and reads like one too) but ... in Qld the Ambulance Levy was attached to our Power Bill!!!!

Why, who knows *. Anyway after a big kerfuffle it was taken off & the State Govt decided the cheaper option was to pay the cost themselves.

* Maybe the Ambo scheme's massive administration costs had been much less when coupled to the administration of power bills which were at the time the responsibility of the State Govt. .. before privatisation of the retail part. Workable perhaps with a Govt monopoly but probably not with a multitude of retailers & customers switching retailers frequently.

Be nice to have the best of all State Govts' concessions .. like the free public transport for NSW Age Pensioners. In Qld we only get a discount .. which is good.

But who's complaining .. not me.

PeterInSa · Guru

re (Any referrals/transfers from point of admission will be covered by government)

My understanding is No, if you are a SA resident, you either need SA ambulance Cover ( you cannot get this if you have Private Medical Benefits and if the occurrence is in another state you need to be covered for Australia wide cover ie at extra cost) or private Health Care Ambulance Cover with extra cover for Non Emergency Ambulance Cover, if the transfer is non emergency. Our Private Health Insurance covers 2 Emergency trips a year.

Re the School yard accident, you could well get the bill from the SA ambulance service, but may be able to claim back against the schools Insurance.

Note: My understanding for SA residents, but please do your own research as your situation may be different.

Peter

-- Edited by PeterInSa on Sunday 23rd of September 2018 07:46:02 AM

delapan · Senior Member

Hi Villatranquilla, you need to read the fine print! As a Vic pensioner myself my wife and i have ambulance subsciption as when interstate only the first trip to hospital is covered as a pensioner, anything susequently is at your expense im afraid, i had the same belief but rang and asked Ambulance Vic and that was the answer. Regards

villatranquilla · Guru

delapan wrote:
Hi Villatranquilla, you need to read the fine print! As a Vic pensioner myself my wife and i have ambulance subsciption as when interstate only the first trip to hospital is covered as a pensioner, anything susequently is at your expense im afraid, i had the same belief but rang and asked Ambulance Vic and that was the answer. Regards

I have had ambulance several trips when interstate and not had to pay a cent.

this quote from their website: could not find anything in the fine print about trip limits

Under the State Concession Scheme, eligible Victorian's holding certain concession cards receive free clinically necessary ambulance coverage throughout Australia. In all cases, transport is provided to the nearest and most appropriate medical facility.

For the purpose of ambulance transport, the Concession classification includes:

A person holding a current Victorian Pensioner Concession Card (includes dependent children listed on the card but not spouses)

A current Health Care Card holder and their dependents including spouses listed on the card (does not include Health Care Card for carer allowance and foster care issued in the name of the child)

A child holding a current Child Disability Health Care Card or Foster Child Health Care Card, but not their guardians/families listed on the card

A child under a Family reunification, Care by Secretary or Long-term care order including children on interim accommodation orders

A person who is subject to an order under the Mental Health Act 2014, Sentencing Act 1991, or Crimes (Mental Impairment and Unfitness to be Tried) Act 1997 requiring them to be compulsorily assessed or treated in a designated mental health service. This includes compulsory, security and forensic patients.

Asylum seekers who are clients of one of the 16 nominated agencies for asylum seeker support found here Ambulance Transport Payment Guidelines

Concession transport from a private healthcare facility

If a concession card holder is transported from a private healthcare facility the sending private facility is responsible for payment. This includes registered private hospitals and registered private day procedure centres.

The private healthcare facility decides whether or not to pass this cost onto the patient.

Concession benefits do not apply when

Concession benefits do not apply when:

A patient only holds a Commonwealth Seniors Health Card and they do not have one of the concession cards listed above
A patient requests to be repatriated or relocated to or from Victoria for non-clinical reasons or when the transport is not clinically necessary (repatriation back to Victoria must be authorised as clinically necessary and there must be a demonstrated clinical requirement for ambulance transport)
Another party is responsible for the account.

The other party responsible could be:

The Department of Veterans Affairs (DVA) where a person holds a Gold or a White Card (subject to the conditions of the card)
The Transport Accident Commission (TAC)
The Victorian WorkCover Association (VWA)

-- Edited by villatranquilla on Sunday 23rd of September 2018 02:19:28 PM

DeBe · Guru

www.flyingdoctor.org.au/assets/files/160503_RFDS_re_SAAS_insurance_cover_FINAL.pdf This may be worth reading as to when charges may aply on a RFDS flight.

Wheels · Veteran Member

Sorry to hear what happened Bookleaf

Some time ago I wrote a post stating that as I am no longer a resident of Victoria as I am travelling Aus. full time and have no home base I was declined Victoria Ambulance cover while I was staying in Fremantle, the reason they gave was that I am not a current resident of Victoria

My health insurance covered the $960 bill, since my discussion with Ambo Vic, I have joined Bupa Ambulance Cover which covers me Aus wide for both emergency and non emergency.

I am a lot happier with Bupa cover than I ever was with Ambo Victoria

I suggest that all readers check their Ambo cover, as a lot of states only cover you for emergencies. Ask the question what happens if I get transferred to another hospital for my well being or there is no room for me and it is not an emergency.

Take care

Graham