HealthAgenda

Research & Insights

Who pays for an ambulance in an emergency?

A growing number of Australians are being hit with unexpected costs for emergency ambulance call-outs. Here’s what you need to know.

Health Agenda
October 2018

If you fall seriously ill or are injured, it’s reassuring to know you can call an ambulance and medical help will be on its way. In an emergency paramedics can save lives.

In NSW alone, an ambulance responds to a 000 call every 26 seconds. In 2016–17 ambulance services attended to 3.3 million people across Australia.

But did you know that ambulance call out fees aren’t covered by Medicare? A survey by finder.com.au found 30% of Australians think they are. This can leave Aussies shocked when they get a bill and realise they may be out-of-pocket hundreds, or even thousands, of dollars.

Adding to the confusion is the fact there’s no national ambulance provider and the way ambulances are billed differs across our states and territories. In some parts of the country, the state government covers the cost of state-provided emergency ambulances, in others you’ll need private health insurance to avoid out-of-pocket costs.

There’s a further level of complexity if you need an ambulance outside of your home state, or the hospital you’re transported to is across a state line.

Here’s a high level explanation of how it works across Australia:

Residents of NSW & ACT

In NSW or ACT

Emergency ambulances aren’t fully covered by the state government unless you hold certain government concession cards. To avoid out-of-pocket costs you should get private health insurance that includes ambulance cover.

HCF hospital and extras insurance covers state provided emergency ambulance services to the nearest hospital able to treat you. On some levels of HCF cover, you may also be able to claim up to $5,000 per person, per year for non-emergency, medically necessary ambulance transport by state providers.

Interstate

If you have HCF hospital cover you’re entitled to fully covered state emergency ambulance transport across most of Australia under a levy arrangement. This excludes services in Qld and SA (and also WA for ACT residents) but you may be able to claim under your HCF cover).

If you have standalone HCF extras cover you may be covered for unlimited emergency ambulance for transport in NSW or ACT. On some levels of cover there’s an annual limit of 1 claim per person and 2 per policy for states other than NSW and ACT.

NSW and ACT residents can also buy standalone ambulance-only insurance for nationwide emergency ambulance coverage.

Residents of Queensland

State ambulance services are covered by your state government Australia-wide, so you don’t need separate insurance.

Residents of Tasmania

State road ambulance services are covered by your state government across Australia, with the exception of Qld and SA. You may be able to claim for services not covered by your state scheme under your HCF cover (limits may apply if you have standalone extras cover).

Residents of Victoria, SA, WA & NT

You need either private health insurance which includes ambulance cover or a subscription with your local ambulance service.

When should I call an ambulance?

Ambulance NSW recommends you call 000 for medical emergencies including:

  • serious accident or injury
  • chest pain
  • uncontrollable bleeding
  • sudden collapse or unexplained fall
  • serious burns
  • if a person is unconscious or having difficulty breathing.

What about non-emergency ambulance use?

If you call an ambulance for a non-emergency, the cost won’t be covered by HCF and may not be covered or subsidised by the government either. You can read more about what’s considered an emergency, and what’s included under emergency and non-emergency ambulance cover, in the HCF Member Guide or Fund Rules.

What should I consider when I get ambulance cover?

“As ambulance cover can be complicated, we recommend you talk to your health fund,” says HCF’s Ann O’Gorman Skarratts. “Like any type of insurance, it’s important to ask questions about your policy and make sure you understand what you’re actually covered for.” 

The Commonwealth Ombudsman recommends you ask whether your cover will include:

  • interstate travel
  • emergency situations only or non-emergency as well
  • different types of ambulance transport, for example air ambulance, state-approved private providers or other private providers
  • ambulance treatment where transportation to a hospital isn’t required
  • the full fee, or whether you’ll have out-of-pocket costs.

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