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Get Form CMS-R-131 2011

BN) NOTE: If Medicare doesn’t pay for the ambulance services below, you may have to pay. Medicare does not pay for everything, even some care that you or your health care provider have good reason to think you need. We expect Medicare may not pay for the ambulance services listed below. Services Reason Medicare May Not Pay: Ambulance transport and mileage ___ Medicare does not pay for transportation from a residence or a SNF for services that could more economically be performed at the res.

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