LifeNet Subscription Program - FAQs
Why do I need a subscription?
Medicare and private insurances only pay a portion of your ambulance bill.
With a subscription, your out of pocket
expenses will be written off, thus prepaying co-insurances, deductibles and certain non-covered expenses. Medicare pays
for transport to the closest facility. Yet, you may need transportation to
another hospital for higher level of care in Shreveport or Little Rock.
What does Medicare or private insurance consider a non-covered expense?
Transportation to physicians offices is not a benefit for Medicare patients and private insurance, even though it may be medically
necessary. Medicare doesn't pay the entire mileage for long distance transports. We accept assignment on Medicare, but we aren't in network with
private insurace companies. Thus, sometimes leaving you with a large out of pocket expense if your insurance company deems the charge excessive or
is not covered under your policy.
I would never call an ambulance for a non-emergency, what benefit would the subscription be to me?
In most cases, ambulances are called in emergency situations by the patient or a family member. However, the hospitals
may call for an ambulance service to transport a patient needing a higher level of care for services not available
at their facility. Patients that need monitoring or have IV's must be transported
by ambulance. Many times, private insurance doesn't pay for these non-emergency transports. As long as
a physcican signs a certification of medical necessity for the transport, the patient will have no out of pocket expense within a 150 mile radius.
What is a Certification of Medical Necessity? And who determines medical necessity?
A certification of medical necessity is used non-emergency transports. The physician certifies that the patient meets the necessary requirements to need a stretcher ambulance
for transport. Medicare sets the bed confinement guidelines. The definition of bed confinement is when a patient is unable to get up from bed without assistance, ambulate and sit in a chair, including a wheelchair. This includes transports from
home, nursing home, physician's office and hospitals. Medical necessity is covered under your subscription if Medicare or private insurance does not pay this expense.
If I have a family member in the nursing home, why do they need a subscription? The nursing home provides transportation.
That is correct. Emergency situations can arise at the nursing home thus
causing the need for an ambulance. The nursing home vans are not allowed to take
patients to the emergency room.
Doesn’t Medicare and private insurance pay for the entire bill?
MMedicare has strict guidelines for payment for ambulance transports.
Medicare's definition of an emergency is the sudden onset of a medical condition manifesting itself by acute symptoms of such severity (including severe pain) that the absence of immediate medical attention could reasonably be expected to result in any of
the following:
* placing the patients health in serious
jeopardy
* serious impairment of bodily functions
* serious dysfunction of any bodily organ
or part.
If deemed medically necessary, Medicare only pays 80% of approved charges often leaving a balance of
more than $70. If private insurance pays, it is often 60% to 80% of approved charges, resulting in balances after insurance to exceed hundreds of dollars. For example Arkansas Blue Cross benefit for ambulance service is $
1000 per year (not per trip).
What if I needed to be transported to another city for heart surgery? Doesn’t Medicare pay?
MeMedicare’s view is that we have heart surgeons available at our local hospitals. Medicare pays
for transport to the closest facility with cardiologists or heart surgeons available, thus many times not paying for the transport
to the actual destination or only paying partial mileage. Subscribers will be transported with no out of pocket expense to hospitals within our 150 mile radius (which includes Little Rock, Shreveport and, in some cases, Dallas) If transported to Dallas, we would honor the 150 miles and bill the difference that wasn’t paid with a 40 % discount.
What if I don’t have insurance?
Your bill will be discounted 40 %. If the bill was $750, a subscriber would only pay $450. This also includes family members in your household that
are covered under your subscription plan.
Can I be transported more than once?
Yes, there are no limits on the amount of transports whether emergency or
non-emergency
If I am out of town and it is medically necessary for me to be transported back to local hospital or rehab hospital, will LifeNet come and get me?
Absolutely, as long as you’re a subscriber we can go into other service areas and return our members to a local hospital, rehab, nursing home, etc. The only qualification is that it must
be of medical necessity due to bed confinement, the need for monitoring, IV’s etc. Once again, a physicians certification of medical necessity must be signed. We have transported many members home from Little Rock, Shreveport and Dallas areas. Most area ambulance services require payment in advance for long distance transfers, a subscription
ensures you the peace of mind that you don’t have to pay in advance and Medicare or private insurance payments are accepted as payment in full.
The brochure states Medicaid clients are entitled to receive Medicaid- Covered ambulance services without paying a subscription fee or make a voluntary contribution. If I have Medicare and Medicaid, do I need a subscription?
Yes, as Medicare is primary. Therefore Medicare guidelines are in effect. This statement is for patients that are Medicaid only. Patients that fit into a financial category and qualify for this program. If medical necessity is met by Medicaid definition, then Medicaid will pay the transport without any expense to the patient.
We hope you don’t have to use an ambulance but if you do, have the peace of mind of knowing that your bills will be filed with her insurance or Medicare and that you or your family will not be responsible for balances from co insurance or deductibles.