Uninsured AMR Services Sample Clauses

Uninsured AMR Services. When insurance does not pay AMR for its services, AMR shall provide the member a 40% discount off its usual and customary charges for its services which are ordered and provided with a good faith belief that the services are medically necessary. MEDICAL NECESSITY: To determine whether any emergency or non-emergency transport qualifies for membership benefits, AMR will use the “medical necessity” 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’s or physician’s convenience, are generally not considered medically necessary. LIMITATIONS & CONDITIONS: Membership benefits only extend to AMR’s advanced or basic life support ambulance services staffed with paramedics and/or EMTs. No benefits are provided for specialized forms of medical transportation such as mobile intensive care transports staffed with one or more registered nurses or other personnel functioning above the normal paramedic level. Membership benefits are inapplicable to services rendered by any other provider. Further, membership does not apply to AMR’s wheelchair van service. As a condition of receiving benefits of membership with respect to any ambulance transport, a member with insurance must comply with all coverage conditions of the applicable insurance program for such transport. Some insurance programs require the insured person to obtain prior authorization of payment for non-emergency ambulance services. Some plans require certain documentation from the insured within a specified time limit, or the plans deny or reduce coverage for ambulance services. In the event ambulance services rendered by AMR to the member are not covered by the member’s insurance due to lack of medical necessity, failure to comply with applicable coverage requirements or for any other reason, or if the member has no applicable insurance, AMR shall provide the member with a 40% discount off of its usual and customary charge for such transport. Membership only covers qualified ambulance services from AMR that begin and terminate within or among Mississippi, Louisiana, Alabama and Georgia. No benefits are provided for services rendered outside this area. I agree to pay AMR for any servi...
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Related to Uninsured AMR Services

  • Provider Services The Contractor’s system shall collect, process, and maintain current and historical data on program providers. This information shall be accessible to all parts of the MCMIS for editing and reporting.

  • Advanced Services As a general matter, shall have the meaning set forth by the FCC.

  • Career Services Placement assistance is not provided. It is understood that the School does not and cannot promise or guarantee neither employment nor level of income or wage rate to any Student or Graduate.

  • Disaster Services In the event of a local, state, or federal emergency, including natural, man- made, criminal, terrorist, and/or bioterrorism events, declared as a state disaster by the Governor, or a federal disaster by the appropriate federal official, Grantee may be called upon to assist the System Agency in providing the following services:

  • Contractor Services Emerald has contracted, on an exclusive basis, with official contractors to provide certain services for the Event. Service companies other than the official contractors will not be allowed to perform any of these exclusive services. Non-exclusive services may be performed by exhibitor-appointed contractors (“EACs”) within certain guidelines. Please refer to the Exhibitor Service Manual for a listing of exclusive services and EAC guidelines.

  • Preventive Care and Early Detection Services This plan covers, early detection services, preventive care services, and immunizations or vaccinations in accordance with state and federal law, including the Affordable Care Act (ACA), as set forth below and in accordance with the guidelines of the following resources: • services that have an A or B rating in the current recommendations of the U.S. Preventative Services Task Force (USPSTF); • immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention; • preventive care and screenings for infants, children, and adolescents as outlined in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA); or • preventive care and screenings for women as outlined in the comprehensive guidelines as supported by HRSA. Covered early detection services, preventive care services and adult and pediatric immunizations or vaccinations are based on the most currently available guidelines and are subject to change. The amount you pay for preventive services will be different from the amount you pay for diagnostic procedures and non-preventive services. See the Summary of Medical Benefits and the Summary of Pharmacy Benefits for more information about the amount you pay. Preventive Office Visits This plan covers the following preventive office visits. • Annual preventive visit - one (1) routine physical examination per plan year per member age 36 months and older; • Pediatric preventive office and clinic visits from birth to 35 months - 11 visits; • Well Woman annual preventive visit - one (1) routine gynecological examination per plan year per female member.

  • Construction Administration Services The Engineer shall perform construction administration services during construction as necessary. Such services shall, as part of the services to be rendered for the Engineer's established fee, include as much of the Engineer's professional services and the services of the Engineer's consultants as the State deems necessary for the well-being of the project and efficient prosecution of the construction work, but shall not include the Engineer's undertaking continuous on-site observation of the work. If the Engineer fails to perform such duties in a conscientious and reasonable manner, the State may exercise its right to terminate this contract as hereinafter provided in Section T. Additionally, it is understood and agreed to by the Engineer and the State that the duties of the Engineer shall include, but not be limited to, the following services:

  • Medically Necessary Services for the State plan services in Addendum VIII. B medically necessary has the meaning in Wis. Admin. Code DHS §101.03(96m): services (as defined under Wis. Stat. § 49.46

  • Provider If the Provider is a State Agency, the Provider acknowledges that it is responsible for its own acts and deeds and the acts and deeds of its agents and employees. If the Provider is not a State agency, then the Provider agrees to indemnify and save harmless the State and its officers and employees from all claims and liability due to activities of itself, its agents, or employees, performed under this contract and which are caused by or result from error, omission, or negligent act of the Provider or of any person employed by the Provider. The Provider shall also indemnify and save harmless the State from any and all expense, including, but not limited to, attorney fees which may be incurred by the State in litigation or otherwise resisting said claim or liabilities which may be imposed on the State as a result of such activities by the Provider or its employees. The Provider further agrees to indemnify and save harmless the State from and against all claims, demands, and causes of action of every kind and character brought by any employee of the Provider against the State due to personal injuries and/or death to such employee resulting from any alleged negligent act by either commission or omission on the part of the Provider.

  • Repair Services RIM, either directly or through its authorized service providers, will provide You with Repair Services using new or refurbished parts or a new or refurbished BlackBerry PlayBook. Any Repair Services under this Agreement are conditioned upon the return of Your BlackBerry PlayBook to RIM or a RIM authorized service provider (as set out in Your RMA form). In the event RIM provides You with a replacement BlackBerry PlayBook (an “Advanced Exchange PlayBook” or “Advanced Exchange Service”) or when the exchange of the BlackBerry PlayBook (or parts thereof) are provided under this Agreement, Your BlackBerry PlayBook or Your BlackBerry PlayBook parts received by RIM or RIM’s authorized service provider become the property of RIM and the Advanced Exchange PlayBook or BlackBerry PlayBook parts sent to You by RIM or RIM’s authorized service provider become Yours.

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