Frequently Asked Questions
Overview and Membership Benefits
How did the AirMedCare Network membership program get started?
Our Network of Providers were among the first air ambulance services to offer a membership program, similar to the ground ambulance and rural fire department programs throughout the United States. The founders knew that for the service to survive in a rural area, they would need other sources of funding besides the traditional fee-for-service billing. Additionally, the founders knew that the service would be costly, and therefore offered a membership program to assist families with the cost and alleviate the financial burden associated.
What is the benefit of membership to you?
Although you do not have to be a member to be transported, membership offers several important benefits:
First, as one of more than 2.6 million members, AirMedCare Network Providers will work on your behalf with your benefits provider to secure payment for your flight, with any uncovered amounts considered to be fully prepaid. As such, members who are transported by AirMedCare Network will not receive a bill for the flight. Importantly, your membership is valid in all of our service areas so you are covered while traveling in those areas. If they determine air medical transport is needed, they will dispatch one of our ambulance providers.
Second, becoming an AirMedCare Network member is a good way to support the health care needs of your local community. Our membership base – the largest of its kind in the United States – helps us operate in rural areas where having a quick response time to critical medical situations can save lives.
How can a membership be so inexpensive and yet still be able to cover the costs of the flights?
Membership fees alone are not enough to cover the cost of member transports. Those fees are prepaid protection against costs not covered by a member’s insurance, other benefits or third party responsibility. Almost all of our members have some type of insurance, benefit or third party responsibility that covers all or part of the cost of transport. Collecting enough from those sources is necessary to keep membership fees low. Of course, if there is no other source of payment for a member’s transport, the transport is still covered in full by the membership.
What is included in a member's insurance, other benefits and third-party responsibility?
These are all potential sources of payment that can be applied to pay for the transport of any patient, including a member patient, by an AirMedCare Network Provider. Accordingly, any type of insurance – health, auto, medical, liability, etc. – that covers ambulance transport services is included. Any benefit – such as another membership that covers medical services, workers’ compensation benefits, etc. – is included. Any third party who is responsible or liable for paying the cost of medical services, such as an at-fault driver of an automobile or the at-fault person’s liability insurance carrier is also included. Medicare is a secondary payor and requires AirMedCare Network Providers to seek payment from third-party liability sources before billing Medicare for patient transports. Many commercial health insurance plans also have rules that, in effect, make third-party liability payments primary. Members agree that the AirMedCare Network Provider is entitled to any and all payment received from insurance, benefit providers and/or any third party for air medical services provided by the AirMedCare Network Provider.
Can I cover all of my family on the membership?
With an AirMedCare Network household membership, any person or persons who reside under one (residential) roof can be covered. In the event we have a member who lives in a duplex or apartment complex, we designate the primary member’s residence/address, and that is considered the “one roof”. Undergraduate college students can be covered under their parent’s membership as well as anyone previously residing in the household who is then moved to a permanent care facility.
Is there a limit to the number of transports a member can have in a year?
There is no limit to the number of transports a member may take in a year. Each transport is handled the same way and must be a life-or-limb threatening emergency.
If I am a member and end up being transported by a ground ambulance or another air ambulance service, who is responsible for the bill?
If an AirMedCare Network Provider does not transport you, you will be responsible for payment of the bill. Our membership program only covers transports provided by our affiliates.
Prepaid Protection for Members
Is an AirMedCare Network membership considered insurance?
No. AirMedCare Network is not an insurance company. An AirMedCare Network membership is not an insurance policy and cannot be considered as secondary insurance coverage or as supplemental coverage to any insurance policy. Membership provides prepaid protection against covered AirMedCare Network provider transportation costs that exceed a member’s health insurance or medical benefits.
Does my primary insurance cover the cost of an AMCN provider transport? If so, how much?
This answer varies, with each insurance company offering different plans and coverage. It is up to your individual insurance company as to whether they will cover the cost of a transport, as well as to the amount of economic burden placed on the patent via a co-pay or deductible. We recommend that you contact your insurance company directly to obtain detailed coverage information.
My insurance company says they will cover 100% so why do I need this membership?
Most insurance companies will pay 100% of what they deem an allowable amount for air ambulance or emergent ground, which does not necessarily mean that the total cost of the transport will be covered. Additionally, people frequently change insurance companies and plan designs. You will want to check with your individual insurance company to find out exactly how much they will cover in the case of an AMCN transport. Lastly, your insurance may decide that the flight does not fit a specific parameter covered under your policy and deny payment. Membership will cover the cost of the flight for you, even if your insurance does not.
If I have Medicaid, do I need a membership?
No. Some state laws prohibit Medicaid beneficiaries from being offered membership or accepted into membership programs. As part of our application process, members certify to AirMedCare Network that they are not Medicaid beneficiaries, with AirMedCare Network providers accepting Medicaid as full payment for services rendered.
If I have Medicare and a supplemental policy, do I need a membership?
The answer varies, depending upon the nature of your transport and your supplemental insurance provider. In many cases, Medicare and the supplemental insurance coverage should pay for the cost of transport if it is medically necessary and if Medicare believes you were taken to the closest appropriate hospital. However, we have seen cases where the supplemental insurance provider does not cover a remaining balance after Medicare has paid its portion. Many seniors have said they want a membership even if they have complete coverage, in the event that their insurance coverage changes in the future or if the claim is denied. Often time’s supplemental insurance won’t pay if your primary denies. In those circumstances, membership is very beneficial.
Provision of Services
If I have a medical emergency, should I call the AirMedCare Network Operations Center emergency line or the local 911 service?
Call your local 911 service. The 911 dispatchers are trained to get specific information about the medical emergency from the caller and determine what type of medical transportation best fits the situation, so the best option is to always call the local 911 service first. The local service is more familiar with your location, as well as the availability of the local emergency resources. They may have information to aid you that the AirMedCare Network Provider Operations Centers may not be aware of.
How would emergency personnel know that I am an AirMedCare Network member?
When calling emergency personnel, you may make the 911/ground ambulance service aware that you are an AirMedCare Network member so that in the event they plan to request an air ambulance, they know your preference is for an AirMedCare Network provider. As a member of AirMedCare Network, you will receive with your membership an identification card and stickers for your vehicle. All of these items allow emergency personnel to identify that you are an AirMedCare Network member. Regardless of whether or not emergency personnel know that you’re an AirMedCare Network member, we may still be called to transport you. As earlier indicated, most of our transports are non-member transports.
Who determines if and when I will be flown?
If your medical emergency meets certain criteria, such as a heart attack, stroke or a traumatic injury and the 911 dispatcher determines you would benefit from emergent ground or air medical transport, they may dispatch an air ambulance to your emergency, as well as a ground ambulance. Hospital-to-hospital transfers are ordered by physicians. In the event that the AirMedCare Network Operations Center receive a call for emergency help from an individual or source other than a healthcare or emergency services agency, AirMedCare Network Providers communication specialists will identify and contact the ground EMS service in the patient’s community and ask them to respond to the scene. If they determine air medical transport is needed, they will dispatch one of our air ambulance provider’s In short, any trained medical professional can make the determination that a transport is necessary.
Does a membership ensure that AirMedCare Network will fly me, no matter what type of medical care I need?
Air ambulances are valuable and scarce resources that should be reserved for those times when a patient is facing a life-or-limb threatening emergency and it is in their best interest to get to medical care in a timely fashion. AirMedCare Network Providers will not transport patients by air if air transportation is not believed to be appropriate.
Who decides where to fly the patients?
When an air ambulance provider is called, time is of the essence. Patients in life threatening situations often need specialty centers to provide the interventions needed. AirMedCare Network Providers will take a patient to the closest appropriate medical facility as determined by physicians or EMS personnel. Whenever possible, physicians or EMS personnel consult with the patient or the patient’s families as these decisions are being made.
Will an AMCN provider always be available if I need one?
There may be times when the AMCN provider aircraft in your area is committed to assisting another patient transport or is out of service for maintenance or inclement weather. In those instances, we may be able to call one of our other AirMedCare Network providers from an adjoining service area. In some cases, however, you may need to be transported by a ground ambulance or another air ambulance service that is not a participating provider in the AirMedCare Network. It is important that you get to the medical care you need as quickly as possible, no matter the mode of transportation, so you will have the best chances for survival and degree of recovery.
Are there other reasons why an AirMedCare Network air ambulance might not be able to fly me?
The primary determinant of whether to accept a flight is always the safety of the patient and our medical flight crews. Federal Aviation Administration restrictions prohibit AirMedCare Network provider from transporting patients under certain conditions, such as, but not limited to, flying in inclement weather, equipment manufacturer limitations, maintenance requirements, age or size.
Collaboration With Other Health Care Providers
What role does AirMedCare Network Providers play in the emergency services community?
Our crews work closely with ground ambulance services and other EMS agencies in our service areas. We recognize that good patient care requires a team effort of everyone involved – from first responders and law enforcement officials to ground ambulance and hospital personnel. We all play separate, but very important roles, in getting the patient to the appropriate medical care. We do not want to replace any emergency service already in place in a community. Our role is to be a resource they can call on when a higher level of care or special mode of transportation is needed.
Does AirMedCare Network work with local ambulances?
Yes. AirMedCare Network Providers work very closely with ground EMS agencies. These agencies request AirMedCare Network to transport their patients when medically necessary. AirMedCare Network also provides appropriate training and education for ground EMS agencies.
Is there a special discount for EMS/Fire/Police people?
No. AirMedCare Network Providers are strongly committed to complying with all applicable healthcare regulatory guidelines, as well as all rules and regulations governing its participation in both Medicare and state Medicaid programs. In order to avoid even the appearance on non-compliance with applicable healthcare regulatory guidelines, AirMedCare Network does not offer discounted memberships to people just because they are healthcare or emergency personnel, given that such special discounts to healthcare or emergency personnel might be viewed as an attempt to influence referrals.
Can other unaffiliated air medical providers honor AirMedCare Network memberships?
For other unaffiliated air medical providers, we do not believe so. Federal law prohibits the routine waiver of co-pays for services covered by Medicare or Medicaid. However, through an ambulance membership program, membership fees are collected in lieu of the collection of co-pays (“co-pays” is used to refer to all types of patient cost-sharing amounts, including co-payments and deductibles). OIG guidance provides that where membership fees collected from members (or members who are Medicare beneficiaries) “reasonably approximate” the amounts that these individuals would expect to spend for cost-sharing amounts over the period covered by the membership agreement, there is, essentially, no impermissible waiver of co-pays. Therefore, where a specific air ambulance supplier (such as AirMedCare Network) operates a membership program and does not bill its members for co-pays associated with its air transport services, this would not be considered to be a prohibited waiver of the co-pays (i.e., the billing and collection of the membership fee would negate any obligation of the specific air ambulance supplier to bill the patient for the co-pay). This analysis does not hold true, however, if a separate, unaffiliated supplier of air transport services (such as an unaffiliated competitor to AirMedCare Network) waives a co-pay for services provided to an AirMedCare Network member. In this case, the competitor has not collected any membership fees from the AirMedCare Network member, because these fees have only been collected by AirMedCare Network. As a result, the competitor has not collected any funds from the patient that would justify refraining from billing the AirMedCare Network member for the co-pay. In summary, if a competitor provides services to an AirMedCare Network member, the competitor is obligated to collect a co-pay from that individual (unless, of course, the AirMedCare Network member is also a member of a qualifying membership program operated by the competitor).
Will AirMedCare Network honor other unaffiliated air medical provider memberships?
No, for the reasons described above. While AirMedCare Network appreciates operating under a team-oriented approach to provide the highest levels of patient care and service in the regions it serves, it is strongly committed to complying with all applicable healthcare regulatory guidelines, as well as all rules and regulations governing its participation in both Medicare and state Medicaid programs, and therefore cannot honor other unaffiliated air medical provider memberships.
Terms & Conditions And Enrollment
What are the terms and conditions of membership?
AirMedCare Network is an alliance of affiliated air ambulance providers* (each a “Company”). An AirMedCare Network membership automatically enrolls you as a member in each Company’s membership program. Membership ensures the patient will have no out-of-pocket
flight expenses if flown by a Company by providing prepaid protection against a Company’s air ambulance costs that are not covered by a member’s insurance or other benefits or third party responsibility, subject to the following terms and conditions:
1. Patient transport will be to the closest appropriate medical facility for medical conditions that are deemed by AMCN Provider attending medical professionals to be life- or limb-threatening, or that could lead to permanent disability, and which require emergency air ambulance transport. A patient’s medical condition, not membership status, will dictate whether or not air transportation is appropriate and required. Under all circumstances, an AMCN Provider retains the sole right and responsibility to determine whether or not a patient is flown.
2. AMCN Provider air ambulance services may not be available when requested due to factors beyond its control, such as use of the appropriate aircraft by another patient or other circumstances governed by operational requirements or restrictions including, but not limited to, equipment manufacturer limitations, governmental regulations, maintenance requirements, patient condition, age or size, or weather conditions.
FAA restrictions prohibit most AMCN Provider aircraft from flying in inclement weather conditions. The primary determinant of whether to accept a flight is always the safety of the patient and medical flight crews. Emergent ground ambulance transport of a member by an AMCN Provider will be covered under the same terms and conditions.
3. Members who have insurance or other benefits, or third party responsibility claims, that cover the cost of ambulance services are financially liable for the cost of AMCN Provider services up to the limit of any such available coverage. In return for payment of the membership fee, the AMCN Provider will consider its air ambulance costs that are not covered by any insurance, benefits or third party responsibility available to the member to have been fully prepaid. The AMCN Provider reserves the right to bill directly any appropriate insurance, benefits provider or third party for services rendered, and members authorize their insurers, benefits providers and responsible third parties to pay any covered amounts directly to the AMCN Provider. Members agree to remit to the AMCN Provider any payment received from insurance or benefit providers or any third party for air medical services provided by the AMCN Provider, not to exceed regular charges. Neither the Company nor AirMedCare Network is an insurance company. Membership is not an insurance policy and cannot be considered as a secondary insurance coverage or a supplement to any insurance coverage. Neither the Company nor AirMedCare Network will be responsible for payment for services provided by another ambulance service.
4. Membership starts 15‡ days after the Company receives a complete application with full payment; however, the waiting period will be waived for unforeseen events occurring during such time. Members must be natural persons. Memberships are non-refundable and non-transferable.
5. Some state laws prohibit Medicaid beneficiaries from being offered membership or being accepted into membership programs. By applying, members certify to the Company that they are not Medicaid beneficiaries.
6. These terms and conditions supersede all previous terms and conditions between a member and the Company or AirMedCare Network, including any other writings, or verbal representations, relating to the terms and conditions of membership.
*Air Evac EMS, Inc. / EagleMed LLC / Med-Trans Corporation /REACH Air Medical Services, LLC — These terms and conditions apply to all AirMedCare Network participating provider membership programs, regardless of which participating provider transports you.
‡In Nebraska, waiting periods are not allowed; however, a member cannot purchase a membership at the time of transport.
How do I enroll?
You can enroll by calling toll-free 800-793-0010 or go to our online enrollment. You may also enroll by contacting your local membership coordinator.
When does my membership take effect?
Membership starts 15 days after AirMedCare Network receives a complete application with full payment; however the waiting period will be waived for unforeseen events occurring during such time.
Information/Data as of June 2012
%22A Word from the California Department of Managed Health Care%22
(A) “BEFORE YOU PURCHASE: If you are currently enrolled in a health maintenance organization (HMO) or other health insurance, the benefits provided by REACH/Cal-Ore Life Flight may duplicate the benefits provided by your HMO or other health insurance. If you have a questions regarding whether your HMO or other health insurance offers benefits for ambulance services, you should contact that other company directly.”
(B) “WARNING: REACH/ Cal-Ore Life Flight is not an insurance program. It will not compensate or reimburse another ambulance company that provides emergency transportation to you or your family. This may occur when 911 Emergency System has independently determined that another company could provide more expeditious service or is next in the rotation to receive a call. This might also occur when REACH/Cal-Ore Life Flight is unable to perform within a medically appropriate timeframe due to a mechanical or maintenance problem or being called on another flight.”
(C) “COMPLAINTS: For complaints regarding REACH/Cal-Ore Life Flight, first attempt to call the plan at 1 800 793 0010. If REACH/Cal-Ore Life Flight fails to resolve the complaint to your satisfaction, contact the Department of Managed Health Care at 1 888 466 2219. The Department’s website is http://www.healthhelp.ca.gov. You may obtain complaint forms and instructions online.”
(D) “OPERATING UNDER CONDITIONAL EXEMPTION: REACH/Cal-Ore Life Flight is operating pursuant to an exemption from the Knox Keene Health Care Service Plan Act of 1975 (Health and Safety Code section 1340 et seq).”