Non-emergency ambulance services. Members who receive medically necessary advanced or basic life support non-emergency ambulance services from AMR shall pay nothing out of pocket, except as specified herein.
Non-emergency ambulance services. Except as stated in the Covered Services section of this Agreement, the Plan does not provide Benefits for Ambulance usage when another type of transportation can be used without endangering the Member’s health. Any ambulance usage for the convenience of the Member, family or Provider is not a Covered Service. This exclusion includes, but is not limited to, trips to an office, clinic, morgue or funeral home. Coverage is not available for air ambulance transport from a Hospital capable of treating the patient because the patient and/or the patient’s family prefer a specific hospital or physician. Air ambulance services are not covered to transport to a facility or long-term dwelling that is not an acute care hospital, such as a nursing facility, physician’s office, or your home.
Non-emergency ambulance services. Medically Nec- xxxxxx ambulance Services to transfer the Member from a non-Plan Hospital to a Plan Hospital or between Plan facilities when in connection with authorized confine- ment/admission and use of the ambulance is authorized. AMBULATORY SURGERY CENTER BENEFITS Benefits are provided for Ambulatory Surgery Center Bene- fits on an Outpatient facility basis at an Ambulatory Surgery Center. Note: Outpatient ambulatory surgery Services may also be obtained from a Hospital or an Ambulatory Surgery Center that is affiliated with a Hospital, and will be paid according to Hospital Benefits (Facility Services) in the Plan Benefits sec- tion. Benefits are provided for Medically Necessary Services in connection with Reconstructive Surgery when there is no other more appropriate covered surgical procedure, and with regards to appearance, when Reconstructive Surgery offers more than a minimal improvement in appearance. In accord- ance with the Women’s Health and Cancer Rights Act, surgi- cally implanted and other prosthetic devices (including pros- thetic bras) and Reconstructive Surgery is covered on either breast to restore and achieve symmetry incident to a mastec- tomy, and treatment of physical complications of a mastec- tomy, including lymphedemas. Surgery must be authorized as described herein. Benefits will be provided in accordance with guidelines established by the Plan and developed in con- junction with plastic and reconstructive surgeons. No benefits will be provided for the following surgeries or procedures unless for Reconstructive Surgery:
1. Surgery to excise, enlarge, reduce, or change the appear- ance of any part of the body;
2. Surgery to reform or reshape skin or bone;
3. Surgery to excise or reduce skin or connective tissue that is loose, wrinkled, sagging, or excessive on any part of the body;
4. Hair transplantation; and
5. Upper eyelid blepharoplasty without documented signif- icant visual impairment or symptomatology. This limitation shall not apply to breast reconstruction when performed subsequent to a mastectomy, including surgery on either breast to achieve or restore symmetry. CLINICAL TRIAL FOR CANCER BENEFITS Benefits are provided for routine patient care for a Member whose Personal Physician has obtained prior authorization and who has been accepted into an approved clinical trial for cancer provided that:
1. the clinical trial has a therapeutic intent and the Mem- ber’s treating Physician determines that participation in the cli...
Non-emergency ambulance services. Non-Emergency ambulance transportation by a licensed ambulance service (either ground or air ambulance), as determined to be medically appropriate, between facilities when the transport is any of the following:
A. From an Out-of-Network Provider hospital to a Network Provider hospital.
B. To a hospital that provides a higher level of care that was not available at the original hospital.
C. To a more cost-effective acute care facility.
D. From an acute facility to a sub-acute setting.
Non-emergency ambulance services. Except as stated in the Covered Services sec tion of this Agreement, the Plan does not provide Benefits for Ambulance usage when another type of transportation can be used family or P rovider is not a Cove red Service. This exclusion includes, but is not limited to, trips to a n office, clinic, morgue or funeral home. Coverage is not available for air ambulance transport from a Hospital capable of treating the patient family prefer a specific hospital or physician. Air ambulance services are not covered to transport to a facility or long - term dwelling that is not an acute care hospital,
