Do you have private insurance? Wondering if your benefit covers an air ambulance transfer? Let our Insurance Specialists take the insurance headache out of your stressful situation.
It is not easy to verify whether your private insurance policy provides benefits for an Air Ambulance transfer. Insurance coverage on air ambulance flights is determined on a case by case basis. There are numerous factors that come into play when establishing whether or not this service is covered. You must know the right questions to ask and be able to interpret the answers in order to confirm if you truly do have coverage. Each patient’s condition and policy benefits are unique. Our Insurance Specialists have the experience and can determine if your claim will be accepted or rejected.
One key factor in the insurance approval process is determining if the Air Ambulance is deemed “Medically Necessary”.
What is “Medical Necessity”?
The American Medical Association developed the “Model Managed Care Contract.” Based on this Model, it was determine that Medical Necessity is defined as follows:
- Health care or services that a prudent physician would provide to a patient for the purposes of preventing, diagnosing, or treating an illness, injury, disease, or its symptoms in a manner that is:
- In accordance with generally accepted standards of medical practice;
- Clinically appropriate in terms of frequency, extent, site, and duration; and
- Not primarily for the economic benefit of the health plans and purchasers or for the convenience of the patient, treating physician, or other health care provider.
Determining Medical Necessity, although a key factor to establish, is only one of many challenges that the family faces in getting their claim paid. Air Ambulance Worldwide has insurance specialists that will navigate the maze inside insurance companies and take the stress away from you. Most air ambulance companies will complete a form or two for you then let you navigate the maze on your own. Not at Air Ambulance Worldwide. We will make every attempt to confirm your coverage, determine the likelihood of your benefit to be paid and finally we will file, track and continue to see the entire process through to the end.
If the attending physician gives a letter of Medical Necessity to the patient or family, does that guarantee payment of the Air Ambulance flight?
Even though your Doctor provides a letter of Medical Necessity, your benefit contract often leaves sole discretion of necessity to the Medical Director of the insurance company. Your doctor may say that a certain procedure or service is required but the doctor at the insurance company may say that the procedure or service is not necessary. At this point you are left with very few options. This is where our insurance specialists get to work. We will continue to pursue payment until the very end while you stay focused on your loved one; not distracted by insurance frustrations.