Air and water ambulance vehicles are specially equipped to transport individuals with life threatening emergencies to the hospital.
Air and water ambulance transportation may be considered medically necessary when ALL the following criteria are met:
BCBSND will only cover air ambulance services to the nearest appropriate medical facility, with the exception of well documented extraordinary circumstances (example: blizzard conditions); and
The individual’s medical condition must require immediate and rapid transportation that cannot be provided by land ambulance; and
At least ONE of the following:
Medical necessity for air or water transportation is established when the individual’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 individual’s survival or seriously endangers the member’s health.
Following is a list of examples of cases for which air or water ambulances could be justified; this list is not inclusive of all situations that justify air or water emergency transportation, nor is it intended to justify air or water emergency transportation in all locales for the circumstances listed.
The transfer of a individual from one hospital to another may be considered medically necessary if medical appropriateness criteria are met and the transferring hospital cannot provide the required level of care needed by the individual.
Examples of such services include:
The ambulance transport is covered ONLY if the hospital to which the individual is transferred is the nearest with appropriate facilities.
Reimbursement will be made for medically necessary transport to the nearest appropriate facility.
Air and water ambulance transportation are considered not medically necessary when the above criteria have not been met.
Non-emergency air or water ambulance services may be considered medically necessary when ALL of the following criteria are met:
*Non-emergency air or water ambulance transport is NOT covered for the convenience of the member, family members/companions, or the provider treating the member.
Examples of non-covered air or water ambulance transportation:
Vehicle and Crew Requirement
The vehicle and crew utilized for air or water ambulance transport must meet all applicable local, state, and federal regulatory certification and licensing requirements.
No additional benefits are available for wait time in situations where additional mileage or wait time is incurred due to circumstances beyond the ambulance pilot’s control.
Treatment, No Transport
Benefits will be provided when an ambulance responds, BLS or ALS treatment is provided, but no transport of the individual takes place (e.g. individual refuses.)
Benefits are not available if no treatment is provided. (e.g. individual pronounced dead before ambulance arrives)