OVERVIEW AND MEMBERSHIP BENEFITS

Transcription

1 OVERVIEW AND MEMBERSHIP BENEFITS What is the benefit of EagleMed 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 1.25 million AirMedCare Network members, EagleMed 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 EagleMed or another AirMedCare Network Provider 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 ( Approximately 200 Aircraft Locations in 28 States) Second, becoming an EagleMed 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. Approximately 90% of our patient transports originate from a super rural or rural zip code as defined by the Centers for Medicare & Medicaid Services (CMS). If it weren't for our members, we would be challenged to provide this lifesaving service in many of these outlying communi ties. What is the AirMedCare Network and what additional benefits do EagleMed members receive? The AirMedCare Network is America's largest air ambulance membership network, providing the highest levels of care and access for you, your family and your community. P a g e 1

2 The AirMedCare Network combines the membership programs of four leading air ambulance operators, the largest of its kind in the United States. Through the AirMedCare Network, each company s membership enjoys the benefits of the membership program across a combined 28 state service area. Each membership applies to any member in a participating company who is transported by another participating company in the AirMedCare Network. All members share the same best-selling membership plan, under the same terms and conditions and at the same low price. Over 200 aircraft locations across 28 states More than 1,250,000 network members Most Commission on Accreditation of Medical Transport Services (CAMTS) accredited aircraft locations in any membership network How can a membership be so inexpensive and yet still be able to cover the costs of the flights? An individual's membership fee covers only a small fraction of the cost of a flight. Our membership support helps subsidize our program, but our primary revenue is derived from our transports, the vast majority of which are non-members; only a fraction of the patients we fly are EagleMed members. What is included in my membership? Members are entitled to transport by an available EagleMed Airplane or Helicopter (or another AirMedCare Network Provider) to the closest appropriate medical facility for medical conditions P a g e 2

3 deemed medically necessary by an attending medical professional (life or limb-threatening, or that could lead to permanent disability). Can I cover all of my family on the membership? With an EagleMed household membership, all individuals who reside at your residence can be covered by the membership. College students can be covered by the household membership if their primary address is the same as your residence. Is there a limit to the number of flights a member can have in a year? There is no limit to the number of flights a member may take in a year. Each flight is handled the same way and must be medically necessary. If I am an EagleMed or AirMedCare Network Provider member and transported by another air ambulance or ground ambulance provider - who is responsible for the bill? If EagleMed or another AirMedCare Network Provider does not transport you, you will be responsible for payment of the bill. Our membership program only covers transports by our service. There are other air ambulance providers who may claim to Honor EagleMed or AirMedCare Network Provider memberships; however, this statement is incorrect. PREPAID PROTECTION FOR MEMBERS Is an EagleMed membership considered insurance? No. EagleMed is not an insurance company. An EagleMed 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 EagleMed air ambulance transportation costs that exceed EagleMed a LLC member's Corporate health Office insurance or medical When Life s benefits. on the Line, P a g e 3

4 Does my primary insurance cover the cost of a flight? If so, how much do they cover? 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 flight, as well as to the amount of economic burden placed on the patient 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% of the cost of a flight, so why do I need a membership? Most insurance companies will pay 100% (depending on the plan) of what they deem an allowable amount for an air ambulance transport, which does not necessarily mean that the total cost of the flight will be covered. Additionally, people frequently change insurance companies and plan designs (many plans require a co-pay). You will want to check with your individual insurance company to find out exactly how much they will cover in the case of an air ambulance transport. 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 EagleMed that they are not Medicaid beneficiaries, with EagleMed 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 air ambulance 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 EagleMed remaining LLC balance Corporate after Office Medicare has paid its portion. Many seniors have P a g e 4

5 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. PROVISION OF SERVICES If I have a medical emergency, should I call the EagleMed 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 EagleMed Operations Center may not be aware of. How would emergency personnel know that I am an EagleMed member? You may make the 911/ground ambulance service aware that you are an EagleMed member so that in the event they plan to request an air ambulance, they know your preference is for EagleMed. As a member of EagleMed, you will receive with your membership an identification card and stickers for your vehicle and front door. All of these items allow emergency personnel to identify that you are an EagleMed member. 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 air ambulance transport, they will 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 EagleMed Operations Center receives a call for emergency help from an individual or source other than a healthcare or emergency services agency, EagleMed communication specialists will identify and contact the ground EMS service in the P a g e 5

6 patient's community and ask them to respond to the scene. If they determine air ambulance transport is needed, they will dispatch one of our Airplanes or Helicopters. Does a membership ensure that EagleMed 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 critical illness or injury and we believe it is in their best interest to get to medical care as rapidly as possible. EagleMed will not transport patients by air if air transportation is not believed to be medically necessary. Who decides where to fly the patients? When an Airplane or Helicopter is called, time is of the essence. Patients in life threatening situations often need specialty centers to provide the interventions needed. EagleMed will take a patient to the closest appropriate medical facility. Whenever possible, physicians or EMS personnel consult with the patient or the patient's families as these decisions are being made. Will an Airplane or Helicopter always be available if I need one? There may be times when the Airplane or Helicopter in your area is committed on another patient flight or is out of services for maintenance or weather-related issues. In those instances, we may be able to call one of our other EagleMed Airplanes or Helicopters from an adjoining service area. In some cases, however, you may need to be transported by a ground ambulance or another air ambulance service. It is important that you get to the medical care you need as quickly as possible, no matter what the mode of transportation, so you will have the best possible outcome and optimum potential for recovery during life or limb-threatening emergencies. Noteworthy - EagleMed in Kansas and the surrounding States and the AirMedCare Network have extensive and redundant coverage areas throughout the United States. P a g e 6

7 Are there other reasons why an EagleMed Airplane or Helicopter 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 EagleMed from transporting patients under certain conditions, such as flying in inclement weather or when weight limits are exceeded; accordingly, we don't transport patients weighing more than 400 pounds. COLLABORATION WITH OTHER HEALTHCARE PROVIDERS What role does EagleMed 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 EagleMed work with local ambulances? Yes. EagleMed works very closely with ground EMS agencies. These agencies request EagleMed to transport their patients when medically necessary. EagleMed also provides appropriate training and education for ground EMS agencies. Is there a special discount for EMS/Fire/Police people? No. EagleMed 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. In order EagleMed to avoid LLC Corporate even the Office appearance of non-compliance with applicable healthcare regulatory guidelines, EagleMed does not offer discounted memberships to people just P a g e 7

8 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. OTHER AIR AMBULANCE PROVIDERS & EAGLEMED MEMBERSHIPS Can other unaffiliated air ambulance providers Honor EagleMed memberships? For other unaffiliated air ambulance 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). The Office of Inspector General (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 EagleMed) 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 EagleMed) waives the co-pay for services provided to an EagleMed member. In this case, the competitor has not collected any membership fees from the EagleMed member, because these fees have only been collected by EagleMed. As a result, the competitor has not collected any funds from the patient that would justify refraining from billing the EagleMed member for the co-pay. In summary, if a competitor provides services to an EagleMed or AirMedCare Network Provider member, the competitor is obligated to collect the co-pay EagleMed from LLC that Corporate individual Office (unless, of course, the EagleMed member is also a member of Main: a qualifying (800) membership Fax: (316) program Transport: operated (800) by the competitor). P a g e 8

9 Will EagleMed Honor other unaffiliated air ambulance provider memberships? No, for the reasons described above. While EagleMed appreciates operating under a team-oriented approach to provide the highest levels of patient care and service in the regions it serves, we 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. Therefore, EagleMed cannot honor other unaffiliated air ambulance provider memberships. TERMS & CONDITIONS AND ENROLLMENT What Are the Terms and Conditions of Membership? An EagleMed ("Company") membership ensures the patient will have no out-of-pocket flight expenses if flown by the Company or another AirMedCare Network participating provider (together with the Company, each an " AirMedCare Network Provider") by providing prepaid protection against AirMedCare Network Provider 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 an AirMedCare Network 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 AirMedCare Network Provider retains the sole right and responsibility to determine whether or not a patient is flown. 2. AirMedCare Network 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 EagleMed governed LLC Corporate by operational Office requirements or restrictions including, but not limited Main: (800) to, equipment Fax: (316) manufacturer Transport: limitations, (800) governmental regulations, maintenance P a g e 9

10 requirements, patient condition, age or size, or weather conditions. FAA restrictions prohibit most AirMedCare Network 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. 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 AirMedCare Network Provider services up to the limit of any such available coverage. In return for payment of the membership fee, the AirMedCare Network Provider will consider its air ambulance costs that are not covered by any insurance, benefits or third party responsibili ty available to the member to have been fully prepaid. The AirMedCare Network 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 AirMedCare Network Provider. Members agree to remit to the AirMedCare Network Provider any payment received from insurance or benefit providers or any third party for air ambulance services provided by the AirMedCare Network 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 air or ground 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. P a g e 10

11 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. The Preceding Terms and Conditions Apply To All AirMedCare Network Providers: How Do I Enroll? You can enroll by calling toll-free or go to our online enrollment. You may also enroll by contacting your local membership coordinator or any EagleMed employee. When Does My Membership Take Effect? Membership starts 15 days after EagleMed receives a complete application with full payment; however, the waiting period will be waived for unforeseen events occurring during such time. If you have any question, the EagleMed and AirMedCare Network Point of Contact for Membership is Jill Burks. She may be reached by telephone at (580) , or by at BurksJill@amgh.us. Sincerely, Larry C. Bugg President EagleMed LLC P a g e 11