Page 7 - Medicare Benefit Policy Manual
P. 7

A legal obligation to pay exists where a religious order either pays for or furnishes
                   services to members of the order.  Although medical services furnished in such a setting
                   would not ordinarily be expressed in terms of a legal obligation, the order has an
                   obligation to care for its members who have rendered life-long services, similar to that
                   existing under an employer’s prepayment plan.  Thus, payment may be made for such
                   services whether they are furnished by the order itself or by independent sources that
                   customarily charge for their services.

                   40.6 - Ambulance Services
                   (Rev. 1, 10-01-03)
                   B3-2306

                   There are numerous methods of financing ambulance companies.  For example, some
                   volunteer organizations do not charge the patient or any other person but ask the recipient
                   of services for a donation to help offset the cost of the service.  Although the recipients
                   may be under considerable moral and social pressure to donate, they are not required to
                   do so, and there is no enforceable legal obligation on the part of the individual or anyone
                   else to pay for the services. Thus, Medicare benefits would not be payable.  However,
                   services of volunteer ambulance corps are not categorically excluded.  Many such
                   companies regularly charge for their services and Medicare covers these services.

                   Some ambulance companies provide services without charge to residents of specific
                   geographical areas but charge non-residents to the extent they are able to pay (e.g.,
                   through private health insurance).  Under those circumstances, the free services provided
                   the residents would be excluded from coverage, while the services furnished non-
                   residents would be covered.

                   Ambulance companies which charge membership fees generally do not charge additional
                   fees for services covered under the membership plan, although they may charge for
                   certain other services (e.g., additional trips or mileage).  Services furnished by such
                   ambulance companies including services for which prepayment is made under the
                   membership plan, are considered to be services for which there is a legal obligation to
                   pay.  Therefore, such services are reimbursable provided the ambulance company bills all
                   third party payers.  Membership fees and insurance premiums are not incurred expenses
                   under Medicare (see the Medicare Benefit Policy Manual, Chapter 15, “Covered Medical
                   and Other Health Services,” §10) and are not reimbursable.

                   50 - Items and Services Furnished, Paid for or Authorized by
                   Governmental Entities - Federal, State, or Local Governments
                   (Rev. 1, 10-01-03)
                   A3-3153, HO-260.3, B3-2309

                   The law contains three separate exclusions applicable to items and services furnished,
                   paid for or authorized by governmental entities.  In general, payment may not be made
                   for items and services:
   2   3   4   5   6   7   8   9   10   11   12