Insurance guidelines for Air Ambulance
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Insurance guidelines for Air Ambulance

Insurance guidelines for Air Ambulance

Air Ambulance Insurance guide

 Air transport is more expensive and involves more potential risk than other methods of transport. The benefits of transport should outweigh risks. Medical necessity is established when the member’s condition is such that the time needed to transport a member by land, or the instability of transportation by land, poses a threat to the member’s survival or seriously endangers the member’s health.

1. The time needed to transport a patient by land or the instability of transportation by land poses a threat to the patient’s medical condition or survival; and
2. The member’s diagnosis and current clinical condition require immediate and rapid transport that cannot be provided by either basic or advanced life support land ambulance; and
3. The proper equipment required to treat the patient is not available on a land ambulance; and
4. The member requires skilled/trained monitoring during transport; and
5. The member is being transferred from an acute care hospital that is not able to treat the member's medical condition to the nearest acute care hospital with appropriate facilities and physician specialists capable of treating the member's medical condition (such as trauma unit, burn unit, or cardiac care unit).
 Examples of emergency situations for which air ambulances may be justified include, but are not limited to, the following: • Intracranial bleeding requiring neurosurgical intervention • Cardiogenic shock • Burns requiring treatment in a Burn Center • Condition requiring treatment in a hyperbaric oxygen unit • Significant multi-system trauma, or trauma requiring immediate surgical intervention at an appropriately equipped center • Amputation • Drowning, near-drowning • Flail chest injury • Neonatal respiratory disease • Uncontrolled bleeding • A hospital patient experiencing shock, sepsis, organ failure with immediate life-threatening implications requiring tertiary care
Air ambulance services are not covered when: • They are for the sake of the patient and/or family preferences, rather than medical necessity, such as to a facility closer to home or family. • They provide transport to a facility that is not an acute care hospital, such as an Acute Rehabilitation Hospital, a Long Term Acute Care Hospital, a Skilled Nursing Facility, a physician’s office, or a member’s home. • Transportation for the purpose of continuity care only; For example, when the member wishes to be seen by his or her own physician specialist who may not be at the nearest appropriate hospital, and not a specialist located at the nearest appropriate hospital. • Transport on commercial airlines or charter flights that are not certified air ambulances. • Transport by an ambulance was medically necessary, but land ambulance service would have sufficed. • Air transport was medically appropriate, but the member could have been treated at a hospital closer than the one to which they were transported.
Managed Care Authorizations are required for air ambulances. Note: As air ambulance service is normally of an urgent or emergent nature, a retrospective review of documentation will be performed prior to payment authorization.

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