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...