Thursday, August 18, 2016

Non network Ambulance would be covered?

Benefit Level for Non-Emergency Ambulance:

The applicable benefit for eligible non-Emergency ambulance transportation depends on the patient pick-up location (origin) as follows:

1. If the patient is inpatient and is transported from a hospital to another hospital or inpatient facility, coverage levels for these ambulance services may vary. Please refer to the enrollee’s specific plan document to determine benefits. The following are UHIC examples for inpatient ambulance transfer:


a. UHIC 2001 COC: The Hospital Inpatient Stay section of the COC

b. UHIC 2007 and 2011 COC: the Ambulance Services section of the COC


2. If the patient is in a sub-acute setting and is transported to an outpatient facility and back (outpatient hospital, outpatient facility, or physician’s office), these ambulance services are covered under the benefits that apply to that sub-acute setting. For example, if the patient is at a Skilled Nursing Facility, the ambulance transport to an outpatient facility (dialysis facility, or radiation whether or not it is attached to a hospital) and back is covered under the Skilled Nursing Facility/Inpatient Rehabilitation Facility Services section of the COC.


Enrollee Pre-Service Notification Requirements for Non-Emergency Ambulance:

• If UHIC initiates the non-Emergency ambulance transportation, enrollee notification is not required.

• If UHIC does not initiate the non-Emergency ambulance transportation certain plans may require the enrollee or the provider to call in for notification. Please see the enrollee-specific plan documents for details on the notification requirements.


Additional Information:

• Provider notification requirements are not addressed by this document.

• Ambulance transportation that is done for convenience of the patient is not covered. Please see the Coverage Limitations and Exclusions section below for more information on non-covered ambulance transportation.

Benefit Level for Non-Network Ambulance (Emergency):

If the ambulance transportation is covered, non-network Emergency ambulance (ground, water, or air), is covered at the network level of deductible and coinsurance.

Additional Information:

• For UHIC Choice, Choice+, and Options PPO plans: Non-network Emergency ambulance is covered at a negotiated rate, or, at billed charges if a negotiated rate is not reached.

• For UHIC Non-Differential PPO plans: The benefits for network and non-network are the same level but these plans do not require billed charges to be paid on non-network ambulance.

• For UHIC Plans without a Network (eg, Managed Indemnity): These plans do not have network benefit levels. These plans do not require billed charges to be paid on ambulance services.

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