Common use of Non-emergency ambulance services Clause in Contracts

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. “Medical necessity” for purposes of determining whether any emergency or non-emergency transport qualifies for the membership benefit shall be determined by AMR using the standards of the Medicare program, which are also used by many other insurance programs. AMR reserves the right to require a certificate of medical necessity from a qualified physician in determining medical necessity. Without limiting the foregoing, transports to doctors’ or dentists’ offices; or outpatient trips to or transfers to another medical facility for the patient’s family or physician’s convenience, are generally not considered medically neces- sary.

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. “Medical necessity” for purposes of determining whether any emergency or non-emergency transport qualifies for the membership benefit shall be determined by AMR using the standards of the Medicare program, which are also used by many other insurance programs. AMR reserves the right to require a certificate of medical necessity from a qualified physician in determining medical necessity. Without limiting the foregoing, transports to doctors’ or dentists’ offices; or outpatient trips to or transfers to another medical facility for the patient’s family or physician’s convenience, are generally not considered medically neces- sarynecessary.