How to Submit a Payer of Last Resort (POLR) Request – Roundtrip

What Is Payer of Last Resort?

Sometimes insurance denies a claim after you already gave the ride. Some hospitals agree to step in as the "payer of last resort" (POLR). That way, you still get paid.

For these hospitals, Roundtrip pays transportation companies on the hospital's behalf. Roundtrip reviews every POLR request before we approve payment.

POLR only applies in instances where Roundtrip is the payment intermediary for Transportation at an individual facility AND our mutual customer includes this as part of their payment processes. That means you send your request to us, not to the hospital.

When to Submit a Request

Submit a request when a rider's transport or ambulance claim is denied. You need:

A primary insurance denial that cites medical necessity or a transport level mismatch

A secondary insurance denial, if the rider had secondary coverage

Common Questions

What if the denial is for lack of prior authorization?

You can still submit. Make sure the denial clearly says the claim was denied for lack of prior authorization.

Do I need proof that a prior authorization request was denied?

No. We need a denial of the claim you filed after the ride. We do not need a denial of a prior authorization request. Send the primary denial, and the secondary denial if one applies.

Do I need to appeal the insurance denial first?

No. You do not need to finish the insurer's appeals process. We only need the denial documents listed above.

What if there was no time to check coverage before pickup?

Submit the request like any other. The result depends on the denial reason. Say the insurer later decides the rider wasn't covered, and the ride already happened. In that case, Roundtrip pays as the payer of last resort.

When We Deny a Request

We deny a POLR request in these cases:

Out-of-network denial. You are responsible for knowing which insurers you are in and out of network with. If the denial says you were out of network, we deny the request.

Vehicle type not covered by Medicare Advantage A and B. If Medicare Advantage A and B is the insurer, and it doesn't cover that vehicle type, we deny the request. Wheelchair vans are one example.

How to Submit

Gather all the documents listed in the table above in the specified format

Document	What It Needs to Show	Format
Ride Details	Patient Name, Roundtrip Ride ID, and Date of Service	Listed in email instructions below
Primary insurance denial	A clear, readable denial with a reason code. The reason must cite medical necessity or a transport level mismatch. The denial must match the date of service.	PDF
Secondary insurance denial	Required if the rider had secondary coverage. It must show the denial is not a coordination-of-benefits issue. If the rider had no secondary coverage, send written confirmation of that instead.	PDF
Ambulance dispatch record or patient care report	Your own record of the vehicle type you sent, the date and time of transport, and the pickup location.	PDF

Missing a document? We will contact you. You will have 30 days to send it. If we don't hear back in that time, Roundtrip will deny the request.

Email the full package to transportation@roundtriphealth.com.

Use this subject line: Payer of Last Resort Request [Name of Transportation Company] [Date of Submission]

Tip: If a hospital tells you to submit a POLR request, send it to us at the email above. Don't send it through the hospital.

Sending several requests at once? Ask us for an Excel template. You can use it to list the details for each request in one file.

Deadlines

What	Deadline
Submit your request	Within 90 days of the secondary payer's denial date. If the rider had no secondary coverage, count from the primary denial date.
Resubmit an incomplete package	Within 30 days of the date we return it.
Send missing documents	Within 30 days of our request.
Answer our questions	Within 30 days. Line items without a response are denied.

What Happens After You Submit

Confirmation. You will receive a ticket number upon submission, please keep this number for reference as you will need it for any follow up.

Review. Our team reviews your request and finishes within 30 days.

Findings. We send you an Excel file with our findings. If your request is approved, it also includes payment timelines. If we have questions, we email the address that sent the request.

Your response. You have 30 days to answer any questions we ask.

If Your Request Is Approved

We pay you at one of these rates, in this order:

Your contracted rate with the hospital, if you have one

The rate listed in your Roundtrip profile, if you have no specific contracted rate

Questions?

Email transportation@roundtriphealth.com and include your ticket number. This will be the fastest way to receive an answer to your inquiry