How to get a patient transferred to another hospital: who has to agree and who pays

Start with the attending physician and the hospital’s case manager. The sending hospital’s doctor has to agree the move is appropriate, the receiving hospital has to agree to take the patient, and the insurance plan can shape the timing. Medicare pays for the ambulance only in narrow cases. This guide covers a patient moving from one hospital to another for care. A short trip to another site for a test, with the patient staying admitted at the first hospital, is a different case, covered in who pays when an inpatient goes to another hospital. Rides home from a hospital are in hospital discharge transportation.

Start with the patient’s status

The rules depend on whether the patient is in the emergency department, admitted as an inpatient, or on observation. EMTALA, the federal law at 42 CFR 489.24, covers people who come to an emergency department with an emergency medical condition. It restricts moving a patient whose condition has not been stabilized. When the hospital admits that person as an inpatient in good faith to stabilize the condition, its EMTALA duty ends. CMS’s State Operations Manual says EMTALA does not apply to inpatients and that the hospital conditions of participation protect them instead.

Observation is not an inpatient admission. CMS says a person placed in observation is not an inpatient, even when they occupy a bed overnight, and that observation does not end EMTALA duties toward someone who came through the emergency department. Ask the nurse or case manager which status the patient has before you ask for anything.

Who has to agree to a transfer

The sending hospital’s physician and the receiving hospital both have to agree. For a patient moving under EMTALA, the transferring hospital must get the receiving hospital’s permission, and CMS expects it to record the date and time of the request and the name and title of the person who accepted. In an EMTALA transfer, the physician at the sending hospital, not the receiving one, decides the mode, equipment and attendants for the trip.

A family can ask, but cannot compel. Under 42 CFR 482.13(b), a patient or representative has the right to make informed decisions and to request or refuse treatment, and the rule says this right is not a way to demand services the hospital considers medically unnecessary or inappropriate. Since July 1, 2025, every Medicare-participating hospital must also have written policies for transferring patients to the appropriate level of care, including another hospital, and train relevant staff on them each year (42 CFR 482.43(c)). Ask the case manager how the hospital handles a transfer request.

Three points decide whether a receiving hospital has to say yes:

• Specialized hospitals must accept some unstable patients. A hospital with specialized capabilities, such as a burn unit, shock-trauma unit or neonatal intensive care unit, may not refuse an appropriate transfer of an unstabilized emergency patient who needs those capabilities if it has the capacity to treat them.
• That duty does not cover inpatients. CMS’s guidance says a hospital may not be cited under EMTALA for refusing to take another hospital’s inpatient.
• Lateral moves are not required. CMS says transfers between hospitals of comparable resources and capabilities are not required by that rule, except when the sending hospital has a serious capacity problem, an equipment failure or a similar situation such as loss of power.

When the patient is not yet stable

A hospital may move a patient with an unstabilized emergency condition only through an appropriate transfer, and only with a written request or a physician’s certification. Under 42 CFR 489.24(e), an appropriate transfer means:

• the sending hospital gives treatment within its capacity that minimizes the risks;
• the receiving hospital has space and qualified personnel and has agreed to accept the patient;
• the sending hospital sends the available records on the emergency condition with the patient, and anything not yet ready as soon as practicable afterward;
• the transfer is carried out by qualified personnel with the equipment the patient needs, including life support measures when medically appropriate.

The patient or a legally responsible person can request the transfer. CMS says the hospital must first explain its duties, including its duty to treat regardless of ability to pay, and the risks of moving. The request must then be in writing, state the reasons, and say that the patient understands the risks and benefits. The other route is a physician’s signed certification that the expected medical benefits of treatment at the other hospital outweigh the added risks of the move.

Records matter for every transfer. The patient has the right to access their own medical records on oral or written request, in the form requested if the hospital can readily produce it (42 CFR 482.13(d)(2)). Imaging and a doctor’s summary in hand help the receiving team on arrival.

When the insurance plan has a say

The plan can hold up a transfer for a stable patient, but a receiving hospital risks an EMTALA violation if it delays an unstabilized patient to check insurance. CMS’s EMTALA guidance says a receiving hospital may violate the law if it delays acceptance of an unstabilized patient while it waits for financial information. It also says it is not a violation to delay accepting a stabilized patient pending verification of financial information, because EMTALA protections no longer apply once a patient is stable. For a planned move between hospitals, call the plan first and ask whether the receiving hospital is in network and whether the plan has to approve the transfer or the ambulance.

Rules vary by plan and by state. Medicare’s ambulance booklet says Medicare Advantage rules, including choices about where to get care, may differ from Original Medicare. Texas Medicaid is one example of a state rule. Its October 2026 ambulance handbook says a facility-to-facility transport may be considered an emergency when emergency treatment is not available at the first facility and the client still needs emergency care. All other facility-to-facility transport is non-emergency and needs prior authorization.

Who pays for the ambulance

Medicare pays for an ambulance transfer only when other transportation could endanger the patient and the move is to the nearest hospital that can give the needed care. Its booklet says Medicare covers ambulance service only to the nearest appropriate facility that can give the care needed. The table shows how that plays out for a hospital transfer.

The rows follow Chapter 10 of the Medicare Benefit Policy Manual (sections 10.3.2, 10.3.3 and 20) and Medicare’s ambulance booklet. When Medicare covers the trip, the patient pays 20 percent of the Medicare-approved amount after the yearly Part B deductible, and the ambulance company must accept the approved amount as payment in full. On a non-emergency trip, the ambulance company must hand the patient an Advance Beneficiary Notice of Noncoverage if it thinks Medicare may not pay for a trip it would usually cover. Read that form before signing, since a signature on the option to proceed means the patient is responsible for the bill if Medicare does not pay.

When a wheelchair van or stretcher van is enough

A stable patient who needs no medical care on the way can go by wheelchair van or stretcher van, and the sending doctor should name the level of transport in the transfer orders. Original Medicare pays nothing for these trips. CMS’s claims manual says neither Part A nor Part B covers ambulette, wheelchair van or litter van rides, or any other transportation that is not an ambulance. The family pays, or a payer that covers it does. Our guide to NEMT or ambulance explains where the line between the two falls, and stretcher transport cost shows what private pay runs.

Air ambulance

Medicare covers an air ambulance between hospitals only when ground transport would endanger the patient and the sending hospital lacks the facilities for the care needed, such as burn, cardiac, trauma or critical care. Its manual adds that coverage is not available from a hospital that can treat the patient because the patient or family prefers a specific hospital or physician. For a privately insured patient, the federal rule at 45 CFR 149.130 limits cost sharing for an out-of-network air ambulance to in-network levels when the plan covers air ambulance, for plan years starting in 2022 or later. That section covers air ambulance services only. Our guide to the No Surprises Act and medical transportation explains who the rule protects.

Moving to a rehabilitation facility or long-term care hospital

When the destination is a skilled nursing facility, an inpatient rehabilitation facility or a long-term care hospital, the patient chooses. Under 42 CFR 482.43(d), the hospital must give the patient a list of participating Medicare providers in the area the patient requests, tell the patient they are free to choose among them, and not limit the providers available. For a patient in a managed care plan, the hospital must also say that the plan’s network needs to be verified. That list-and-choice duty is written for those destinations, not for a move between acute care hospitals.

If the hospital says no

Ask the doctor for the medical reason, in plain words, and ask which of three things applies: the patient is not stable enough to travel, the receiving hospital has not agreed, or it lacks space or qualified staff. Those are the conditions 42 CFR 489.24(e) sets for moving a patient with an unstabilized emergency condition. Every hospital must have a grievance process and a way to tell patients whom to contact. Its response must come in writing and include the contact person, the steps taken, the results and the date the review ended (42 CFR 482.13(a)(2)). The same rule requires a way to refer concerns about quality of care or premature discharge to the Quality Improvement Organization.

For the ride company handling a hospital transfer

Hospital transfers are booked on short notice with specific mobility needs. In HealthRide, wheelchair, stretcher and oxygen needs are matched to the right vehicle, and hospital staff can request the ride, follow the vehicle live and view and pay invoices from a portal. Riders and families can follow their driver live from a text link. See the live map.