Ambulance services are a recognized part of the healthcare system, but not all respond to 911 calls or handle life-threatening emergencies. Many ambulance vehicles are operated by private companies that focus on scheduled, non-urgent medical transportation. These services move patients who require medical oversight or specialized equipment but are not experiencing an immediate crisis.
Defining Non-Emergency Medical Transport
A private ambulance service primarily provides Non-Emergency Medical Transport (NEMT), which is distinct from the municipal 911 Emergency Medical Services (EMS) that respond to sudden crises. Private companies are nongovernmental entities that generate revenue through user fees and third-party billing. Their primary function is planned, scheduled patient movement rather than rapid emergency response.
The level of medical attention provided during NEMT is categorized based on patient need. Basic Life Support (BLS) is the most common level, staffed by Emergency Medical Technicians (EMTs) who provide non-invasive care. This includes monitoring vital signs, administering oxygen, and performing basic wound care, but excludes advanced procedures or most medication administration.
Private ambulances may be staffed for Advanced Life Support (ALS) if the patient requires continuous intravenous fluids, cardiac monitoring, or ventilator support during a planned transfer. For insurance purposes, including Medicare and Medicaid, non-emergency ambulance transport must be deemed “medically necessary.” This means the patient’s condition prevents them from safely traveling by any other means, such as a taxi, private car, or wheelchair van. Medical necessity is based on the patient’s structural, functional, or mental impairments.
Common Situations Requiring Private Ambulance Use
Private ambulances are used when a patient’s condition requires medical attention or specialized equipment that standard transportation cannot provide, but their life is not in immediate danger. One common application is for inter-facility transfers, moving a patient between two different medical locations. This might be a movement from a smaller hospital to a larger facility for specialized treatment, or a transfer to a long-term care facility, rehabilitation center, or skilled nursing home.
These transports are necessary because the patient is bed-bound, requires a stretcher throughout the journey, or needs continuous oxygen or medical monitoring equipment managed by trained personnel. The presence of EMTs ensures that any unexpected change in the patient’s condition during transit can be immediately managed. A standard vehicle is considered medically contraindicated.
Another frequent use is for scheduled, repetitive treatments, such as transporting patients to and from dialysis or chemotherapy appointments. Patients undergoing these procedures are often weak, fatigued, or have medical lines that require supervision, making it unsafe to use conventional transport. For hospital discharges, a private ambulance is used when the individual is unable to sit upright, cannot walk, or requires a stretcher to be moved back to their private residence. Scheduling these services in advance ensures timely arrival without the uncertainty of an emergency-prioritized 911 dispatch system.
Understanding the Cost and Billing Structure
The financial structure for private ambulance services differs significantly from public emergency services. The cost of transport is billed directly to the payer—the patient, a hospital, or an insurance provider. The total charge is calculated based on a base rate, the level of care provided (BLS or ALS), and a mileage fee.
For non-emergency transport to be covered by government programs like Medicare or Medicaid, the service requires a written order from a physician confirming medical necessity. For repetitive, scheduled transports, insurance carriers often require “prior authorization.” This means the service must be approved by the insurance company beforehand; without this pre-approval, the claim is likely to be denied, leaving the patient responsible for the full cost.
Even when insurance covers the transport, patients frequently have out-of-pocket expenses, including deductibles, co-pays, or co-insurance amounts. Because reimbursement relies heavily on detailed documentation proving medical necessity, a lack of supporting paperwork can lead to claim rejection. Patients should confirm coverage and the need for prior authorization with their insurance carrier before scheduling to understand their financial liability.