HMO Guide for Seniors - Office of the Patient Advocate - State of ...

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Questions & Answers
What if I have an emergency
and the nearest hospital is
not in my Medicare HMO’s
network?
Your Medicare HMO must
cover emergency care at any
hospital. But you should
call your HMO as soon as
you can. You may be moved
to a hospital in your HMO’s
network as soon as your
condition is stable.
Are ambulance services
covered?
Yes. Your Medicare HMO
must cover ambulance
services to take you to a
hospital in an emergency.
I got a bill for ambulance
services. Do I have to pay it?
Check your bill. If it is for
a co-pay, you should pay it.
If it is a bill for the full
amount of the services,
submit it to your Medicare
HMO’s claims department.
things you can do
Be Prepared
Know your Medicare HMO’s rules for getting
emergency and urgent care.
Ask about the co-pays for emergency room visits
and ambulance services.
Know the hospitals and urgent care centers in
your HMO’s network.
Always keep your Medicare HMO membership
card with you.
Use an ambulance only for an emergency. If you
need a ride home from the hospital, use a taxi or
paratransit van.
If You’re Not Sure It’s an Emergency
Sometimes it is hard to know if you need emergency
care. If you have time, call your doctor or HMO.
Many HMOs have 24-hour nurse advice helplines.
When You Travel
All Medicare HMOs pay for emergency and urgent
care nationwide. Ask your HMO if it covers any care
outside the U.S.
where to find help
Police, Fire, or Ambulance
Emergency services
9-1-1