The patient’s condition is an emergency that renders the patient unable to go to the hospital by other means. Emergency ambulance services are services provided after the sudden onset of a medical condition. Acute signs and/or symptoms of sufficient severity must manifest the emergency medical condition such that the absence of immediate medical attention could reasonably be expected to result in one or more of the following:
- Place the patient’s health in serious jeopardy.
- Cause serious impairment to bodily functions.
- Cause serious dysfunction of any bodily organ or part.
BestCare responds immediately at the Basic Life Support (BLS) or Advanced Life Support 1 (ALS1) level of service to a 911 call or the equivalent in areas without a 911 call system. An immediate response is one in which the ambulance supplier/provider begins as quickly as possible to take the steps necessary to respond to the call.
Non-emergency ambulance services may be those that are scheduled in advance (scheduled services being either repetitive or non-repeating.
Medical necessity is established for non-emergency ambulance services when the patient’s condition is such that the use of any other method of transportation (such as taxi, private care, wheelchair van or other type of vehicle) would endanger the patient’s health. Insurance may cover non-emergency ambulance transportation if the beneficiary is bed-confined or if the patient’s medical condition is such that transportation by ambulance is medically required whether or not the patient is bed-confined.
Any ambulance trip that does not meet the emergency definition criteria would be determined to be a non-emergency service. This includes:
- All pre-scheduled transport runs.
- Transport to nursing home or patient’s residence.
- Transport to and from medical treatments, appointments or End Stage Renal Disease (ESRD) facilities for scheduled dialysis.