Clalit, Maccabi to start paying ambulance costs automatically

Such an arrangement also will be available to members of Meuhedet Health Services and Leumit Health Services – the two smallest public health insurers – in the near future.

By JUDY SIEGEL-ITZKOVICH
Updated: SEPTEMBER 3, 2017 00:42
Ambulance (photo credit: MAGEN DAVID ADOM JERUSALEM)
Ambulance
(photo credit: MAGEN DAVID ADOM JERUSALEM)
Beginning on Friday, Clalit Health Services and Maccabi Health Services will pay for Magen David Adom ambulance- evacuation services automatically, freeing members from wading through red tape to be reimbursed.
Such an arrangement also will be available to members of Meuhedet Health Services and Leumit Health Services – the two smallest public health insurers – in the near future.
To date, every patient who had to be transported to the hospital in an emergency situation (not for a routine visit) received a bill for MDA services at the emergency room, which led to many forgetting about their payment obligation altogether – whether that be with their health insurance, National Insurance Institute, the IDF or paying for it themselves.
Now, patients who are members of the two larger insurers will no longer receive the payment form in the hospital. Instead, it will be produced by MDA immediately after the person is brought to hospital, and MDA will handle the financial arrangements directly with the health fund or other body that will cover the cost. Eighty five percent of all Israelis are members of the two largest health funds.
Should the patient’s health insurer determine that the patient is not eligible for coverage of the evacuation cost, MDA will pass the bill on to the patient with an explanation of the process.
Members of Meuhedet and Leumit will receive the bill in the mail several days following the evacuation and will be required to forward the form to their insurer. MDA said it is negotiating with the two about including them in the arrangement.
Soldiers are eligible for full coverage of the evacuation cost by the IDF, and MDA will handle the payment process without the soldier’s involvement.
If a person is treated on the scene and not evacuated to a hospital, the individual is obligated to pay, and a bill will be mailed to his address several days later.
An evacuated person is eligible for full coverage of the cost by their health fund in the following cases:
• Loss of consciousness in public
• A woman labor who gives birth within 72 hours of the evacuation (if she was admitted to the hospital and did not give birth within three days, she will be eligible for health insurance coverage of her evacuation cost.
In both cases, MDA will handle the payment directly with the insurance company.
• Work accidents (full coverage even if the person is not admitted to the hospital after being brought by ambulance).
• Road accidents (the patient is eligible for full coverage even if not admitted to the hospital).
If the patient is admitted to the hospital, the health fund will cover evacuation costs. If the patient is evacuated from the scene of the accident in a mobile intensive care unit but is not admitted to the hospital, the evacuation is free of charge.
If he is taken in a regular MDA ambulance but not admitted to the hospital, costs will be covered by the health fund.
• Evacuation of IDF soldiers will be handled directly between MDA and the IDF, without the soldier’s involvement.
• Death. If ambulance teams try to resuscitate a person in the field, the family of the deceased will get a full refund of evacuation charges from their health fund. If the person dies without resuscitation, for whatever reason, the family will receive a bill in the mail and have to handle it directly with MDA .