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Provider Manual

Ambulance Transportation

Last Updated on May 21, 2020

Family Health Center covers air and ground ambulance transportation in the following scenarios. All transportation must be to a Family Health Center contracted facility/provider in order to be covered.

  • Emergency transportation to the closest contracted hospital that can handle the necessary level of care
  • Transportation from contracted emergency room to contracted emergency room at another facility due to needing a higher level of emergency room care
  • Transport from ER to a contracted hospital where patient is admitted as outpatient, inpatient, or for observation
  • Air ambulance is covered in critical emergency situations when the ground ambulance is not medically safe or appropriate and member is transported to a contracted hospital. See the prior authorization information section below.
  • Ambulance call but the member was pronounced dead by a legally authorized individual (physician or medical examiner) and no transportation was required
  • Ambulance call when no transport is required

The below transportation services require prior authorization. Please review ‘Ambulance: Land and Air Transportation’ medical policy on the Medical Policies page for coverage criteria.

  • Air ambulance services require prior authorization. If no prior authorization is on file, then a retrospective review will be performed using the criteria listed in the Security Health Plan Medical Policy.
  •  Non-emergent medical transportation

Family Health Center does not cover the following services. Services will be denied to the patient.

  • Ambulance services if transportation is to a non-contracted facility
  • Ambulance transport from one inpatient stay to another inpatient stay
  • Ambulance transport to a home, outpatient setting or to a skilled nursing facility (SNF)
  • Medivans, rescue squad or first responders