Ambulance
Transportation – 90%
Benefits are
provided for services and supplies for licensed ambulance transportation to the
nearest hospital or Medicare-approved skilled nursing facility which has the
appropriate facilities to treat the individual’s condition when the
individual requires immediate medical intervention as a result of a severe, life
threatening or potentially disabling condition, and only if any other means of
transportation would seriously endanger the individual’s health,
or:
- Ambulance
service is from one hospital to another, including return, but only in
situations where evidence clearly establishes that the institution to which an
individual is being transferred is the nearest one having appropriate
facilities, equipment or staff physicians to treat the individual’s
condition or to obtain medically necessary diagnostic or therapeutic services
not available at the individual’s hospital or skilled nursing
facility.
- Licensed
air ambulance if medically necessary but then only to the nearest medical
facility that can provide the needed medical treatment. Air ambulance services
are covered only when (1) the point of pickup is inaccessible by land; or (2)
great distances or other obstacles are involved in getting the individual to the
nearest appropriate facility, and speedy admission is essential. If it is
determined that a land ambulance would have sufficed, this plan pays only the
amount it would have paid for land ambulance.
Scheduled
air transports must be preauthorized with the Trust
Office.
If
the individual is transported beyond the nearest appropriate facility, benefits
are pro-rated
accordingly. Benefits
are
not
provided for:
Ambulance
use to or from the individual’s home and a physician’s
office. Cabulance
services or any other commercial transportation. Transportation
for the individual’s or provider’s convenience.
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