LifeNet, Inc., has the resources and willingness to file your primary insurance. As a courtesy, we are happy to make reasonable efforts to help you receive reimbursement for insurance or other third party programs to which you belong. However, payments of fees are the patient’s responsibility and the success (or lack of success) in securing reimbursement from a third party does not lessen your obligation to pay LifeNet promptly.
Our terms are cash or insurance. Questions regarding financial matters should be directed to our Business Office (903-832-8531) who will be happy to work with you on such matters. Financial Assistance Applications are available here.
Due to federal regulations we cannot waive any co-pays. The Business Office will assist with insurance filing and appeals, and account resolution.
LifeNet is a not-for-profit corporation. We receive no direct grants or funds from any governmental agency except those programs which are open to all ambulance providers and make reimbursements for services actually rendered, such as Medicare, Medicaid, Champus, State Rehabilitation, etc. Government and State programs do not reimburse the full amount of charges.
LifeNet is committed to conducting its business in a lawful and ethical manner. We comply with all applicable federal, state and local laws.
INSURANCE TERM GLOSSARY
The following forms and documents are made available to assist our patients in obtaining their records and to gain a better understanding of their patient rights. Documents are available in Adobe Acrobat (PDF).
Completed forms can be faxed to 903-832-0215
An agreement in which you instruct your insurance organization to pay the hospital, physician or medical supplier directly for your medical services. Your insurance organization decides the payment rate.
The amount owed to LifeNet indicated on the billing statement.
Debt incurred for medical service a health care provider or medical facility provided.
Private or employer base health insurance.
An amount established by the insurance company as the patient’s responsibility of billed fees.
How insurance organizations determine the primary payment source when you’re covered under more than one insurance organization or group medical plan. Your insurance contract states that if you are covered under more than one insurance plan, benefits will be coordinated so that total benefits paid will not be more than 100% of the bill. COB for children covered by both parents is determined by the parent with the earliest birthday (month and day only) in a calendar year
Specific services or supplies for which your insurance reimburses you or pays your health care provider. These consist of a combination of mandatory and optional services and vary by insurance benefit plan.
An amount determined by the insurance company to be paid on an annual basis before benefits are paid to the provider.
A document provided by the patient’s insurance plan/Medicare detailing how benefits are processed and paid for services rendered.
The person responsible for paying the bill.
A service not covered under the limits of the patient’s health insurance contract. These amounts are the patient’s responsibility to pay. Patients should direct questions about coverage to their insurance plan.
A health care provider who isn’t under contract with an insurance organization to accept patients and receive the insurance organizations approved amount on all claims. (You pay the difference between its approved amount for a service and this health care provider’s charge.)
A health care provider who contracts with an insurance organization to accept patients and receive the insurance organizations approved amount on all claims.
Requirement of your insurance company to determine medical necessity for services rendered. Pre-certification does not guarantee benefits for payment. Benefits are based on policy provisions in force at the time services are rendered. Questions about pre-certification requirements in your contract should be directed to your insurance plan.
The insurance organization with first responsibility for paying eligible insurance expenses for your medical service (after you have paid your deductible, co-payments, etc.). Your secondary or other insurance (if you have other insurance) would work with your primary insurance organization to cover eligible expenses according to your insurance policies.
A valid insurance card including the address where claims are to be filed.
The insurance organization with second responsibility for paying eligible insurance expenses for your medical service (after you have paid your deductible, co-payments, etc.). This insurance (if you have it) would work with your primary insurance organization to cover eligible expenses according to your insurance policies. This insurance organization is billed second – after your primary insurance organization has been billed and processed your claim.
A record of account status sent to patients monthly to advise of the previous period’s transactions and activity on the account.
The insurance organization with third responsibility for paying eligible insurance expenses for your medical service (after you have paid your deductible, co-payments, etc.). This insurance (if you have it) would work with your primary and secondary insurance organizations to cover eligible expenses according to your insurance policies. This insurance organization is billed third – after your primary and secondary insurance organizations have been billed and processed your claim.
A patient without medical insurance.
Because we care about you
LifeNet’s billing office staff will do everything possible to exhaust all possible private or third party reimbursement for ambulance fees on our members’ behalf.
Why Become a Member?
LifeNet members will receive up to a 40% discount on billed ambulance services and will be responsible for the remainder of billed charges. LifeNet membership benefits are restricted to “medically necessary” services. These benefits cover emergency and non-emergency response and transportation to healthcare facilities in LifeNet’s service area where alternative forms of transportation (e.g. wheelchair transport, private car, taxi) would be medically inappropriate given the patients condition. Patient must provide upon request physician documentation of medical necessity for non-emergency transports.
Because we care about you before, during, and after an ambulance response, LifeNet’s billing office staff will do everything possible to exhaust all possible private or third party reimbursement for ambulance fees on our members’ behalf. If a member’s Medicare or private insurance denies a ground or air ambulance claim for any reason, LifeNet will appeal the claim. Only after LifeNet has appealed and the claim is still denied, will LifeNet discount a member’s ambulance bill by 40% and send them an invoice for services rendered.
In addition, by purchasing a membership you are investing in a vital community service. Your monetary investment provides health education and community awareness programs and assists in the purchase of equipment thus enabling us to remain progressive to the needs of the community and provide the best care possible.
Gold Plan ($135) covers both air and ground ambulance services
Air Plan ($90) covers air ambulance service up to 250 miles
Standard Plan ($75) covers ground ambulance service up to 500 miles
A LifeNet Membership is Not Insurance
LifeNet’s memberships are convenient methods of eliminating insurance deductible fees and insurance co-payments.
Uninsured members or transports not meeting insurers’ medical necessity requirements will receive a 40% discount on billed charges.
Members are responsible for the payment of ambulance services. LifeNet or Atlanta Fire Dept. may require information or documentation to process insurance claims for services provided by LifeNet or Atlanta Fire Dept. For more information on membership benefits, please see our full Membership Agreement.
Medicare and private insurances pay only a portion of your ambulance bill; with a LifeNet membership, out of pocket expenses will be written off, thus prepaying co-insurances, deductibles and certain non-covered expenses. Medicare pays to the closest facility. You may need transportation to another hospital for higher level of care in Dallas, Houston, Little Rock or Shreveport.
- Non-emergency transports to a physician’s office where alternative forms of transportation would be inappropriate given the patient’s condition
- Interfacility ground ambulance transports for higher level of care within 500 mile radius
- Non-emergency round-trip ambulance transports from residence to hospital
- Non-emergency transports from residence to residence within 500 mile radius
- The medical helicopter will not be first response. Flight must originate from hospital and must be in our primary service area or be requested by a medical professional within LifeNet’s primary service area.
- Subscribers are entitled to transport by LifeNet, Inc. helicopter to the closest facility for injuries that are deemed by an attending medical professional to be life or limb threatening, or that could lead to permanent disability.
- Patient’s medical condition will dictate whether or not air transportation is in the best interest of the patient’s health and well-being. In certain conditions of compromised health, LifeNet reserves the right to determine whether or not a patient is flown.
- Federal Aviation Administration (FAA) restrictions prohibit LifeNet from transporting patients weighing over 400 pounds, or flying in inclement weather conditions. The primary determinant of whether to accept a flight regardless of the factor, be in patient size, weather conditions or some other factor, is always the safety of the patient and our medical crews.
- LifeNet services may not be available at the time of request for services due to factors beyond LifeNet’s control, such as use of the appropriate aircraft by another patient or other circumstances governed by operations requirements such as regulations and maintenance.
A LifeNet ground subscription is available to residents of Bowie, Cass Fire District 1 and 2, Bloomburg Fire District, Garland, Miller, Little River, and Red River
Counties. Our subscription agreement includes transportation by the Atlanta, Texas Fire Department EMS and ensures you coverage in their service area as well.
If you live within LifeNet’s service area, non-emergency transports are covered if either the origin or destination is inside LifeNet’s service area.
LifeNet is prohibited from responding to emergency calls outside LifeNet’s service area, and this agreement will not apply to ambulance services not provided by LifeNet or Atlanta, Texas Fire Department EMS.
The Gold plan offers helicopter service in the following counties: Bowie, Cass, Hempstead, Hot Springs, Little River, Miller, Nevada, Ouachita, Red River, and Sevier Counties.
Transportation to physician’s offices is not a covered benefit for Medicare and private insurance patients, even though it may be medically necessary. Medicare doesn’t pay all the mileage for long distance transports. We accept assignment for Medicare, but LifeNet isn’t in network with private insurance companies; thus leaving you with a large out of pocket expense if your insurance company deems the charge excessive or not covered under your policy. Your LifeNet subscription would eliminate your balance.
I would never call an ambulance for a non-emergency, what benefit would the LifeNet membership be to me?
In most cases an ambulance is requested in an emergent situation by the patient, a family member or a bystander. However, the hospitals requests ambulance service to transport a patient that requires a higher level of care for services not available at first hospital. Patients requiring monitoring or an IV must be transported by ambulance. Many times private insurance doesn’t pay for the non-emergency transports. As long as a physician signs a certification of medical necessity for the transport, the patient will have no out of pocket expense within 500 mile radius.
A certification of medical necessity is required for all non-emergency transports. The physician certifies that the patient meets the necessary requirements to need a stretcher ambulance for transport. Medicare sets the medical necessity guidelines. The definition of” bed confined is a patient that 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 a family member is living in a nursing home, why do they need a LifeNet membership? The nursing home provides transportation.
This is true; however nursing home transportation is not available 24 hours a day and 7 days a week. LifeNet does provide medical transportation 24/7. Emergency situations can arise at the nursing home thus requiring the need for an ambulance. Nursing home transportation is not allowed to take patients to the emergency room.
Medicare has strict guidelines for payment for ambulance transports. Medicare’s definition of emergency means services provided after 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 patient’s 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 $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 $1,000 per year.
Medicare’s view is that we have heart surgeons available at our local hospitals. Medicare reimburses to the closest facility that has cardiologists or heart surgeons available, thus many times not paying for the transport or only partial mileage. LifeNet Subscribers with Medicare or private insurance will be transported with no out of pocket expense to hospitals within our 500 mile radius (which includes Dallas, Houston, Little Rock, Shreveport and Tyler).
Your bill will be discounted 40%. An average emergency bill is approximately $750. A LifeNet subscriber would pay just $450. This includes family members living in your household. The LifeNet Subscription Program also includes family members visiting your household.
A new subscribers may join at any time; however, the cost will remain the same and will expire one year from that date. There is a (7) day waiting period from application to start of coverage for new subscribers.
Yes, there are no limits on the amount of transports whether emergency or non-emergency. Private insurances or Medicare are always billed on all transports.
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 LifeNet subscriber we are allowed into other service areas and meeting medical necessity, either bed confinement, and/or monitoring, IV’s, oxygen, etc. Once again a physician’s certification of medical necessity must be signed. LifeNet has transported many members home from Dallas Little Rock, Shreveport and surrounding areas. Most area ambulance services require payment in advance for long distance transfers, a LifeNet 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 LifeNet brochure states Medicaid clients are entitled to receive Medicaid-Covered ambulance services without paying a membership fee or make a voluntary contribution. If I have Medicare and Medicaid, do I need a membership?
Yes, if Medicare is primary, Medicare guidelines are in effect. This statement is referring to patients that are Medicaid only. Medicaid recipients meet the qualifications for a Medicaid program and also meet the medical necessity guidelines will not benefit from a LifeNet Subscription. Medicaid will pay the transport without any expense to the patient.