Archived Policies - Administrative
Ambulance and Medical Transport Services
Ambulance services are eligible for coverage when following guidelines as outlined below:
a) no bed is available,
b) a burn unit is required,
c) special diagnostic equipment is needed,
d) the trauma unit is full, or
e) a specialist or surgeon is not on call or is not available.
Air or sea ambulance services are eligible for coverage as outlined below:
The following services, items, or conditions are not eligible for coverage:
Non-emergency transports are defined as ambulance transports for a patient who has a medical problem requiring treatment in another location and is so disabled that the use of an ambulance is the only appropriate means of transfer. "Disabled" means the patient's physical condition limits his/her mobility and requires that the patient is unable to stand and sit unassisted or requires continuous life support systems.
Situations where non-emergency transportation may be medically necessary for the patient described above include:
a) renal dialysis facility,
b) radiation therapy center.
Transfers by "medical" vans or commercial transportation (such as physician owned limousines, public transportation, cabs, etc.) are not reimbursable.
Ambulance services involve the use of a specially designed and equipped automotive or other vehicle, licensed by the state, and regulated by local, state and federal laws, to transport the ill or injured. Ambulances can be classified as either basic life support or advanced life support depending upon how the vehicle is equipped. This in turn regulates the level of care that can be provided in the actual transport.
Each benefit plan, summary plan description or contract defines which services are covered, which services are excluded, and which services are subject to dollar caps or other limitations, conditions or exclusions. Members and their providers have the responsibility for consulting the member's benefit plan, summary plan description or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply. If there is a discrepancy between a Medical Policy and a member's benefit plan, summary plan description or contract, the benefit plan, summary plan description or contract will govern.
The following services and supplies are not separately payable whether in an Advanced Life Support or Basic Life Support. If any of these are billed, combine the charges with the ambulance base rate:
Air Ambulance: Reimbursement for transport includes lift off. Allowances for mileage will continue to be based on loaded miles only.
|Title:||Effective Date:||End Date:|
|Ambulance and Medical Transport Services||12-15-2018||06-14-2019|
|Ambulance and Medical Transport Services||07-01-2018||12-14-2018|
|Ambulance and Medical Transport Services||10-01-2017||06-30-2018|
|Ambulance and Medical Transport Services||12-01-2016||09-30-2017|
|Ambulance and Medical Transport Services||08-01-2016||11-30-2016|
|Ambulance and Medical Transport Services||07-15-2015||07-31-2016|
|Ambulance and Medical Transport Services||09-15-2014||07-14-2015|
|Ambulance and Medical Transport Services||08-01-2008||09-14-2014|
|Ambulance and Medical Transport Services||11-15-2007||07-31-2008|
|Ambulance and Medical Transport Services||09-15-2004||11-14-2007|
|Ambulance and Medical Transport Services||07-01-2004||09-14-2004|
|Ambulance and Medical Transport Services||11-01-1997||06-30-2004|