Wellcare Dual Liberty (HMO D-SNP) (001): Ambulance Services
Ambulance services can be either emergency medical (EMT) or non-emergency medical transport (non-EMT or NEMT).
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EMERGENCY (EMT): In an emergency situation, call 9-1-1 and request an ambulance.
NON-EMERGENCY (Non-EMT or NEMT): To book your ride, call the transportation number on the back of your
member ID card.
It is best to contact the ambulance non-emergency line to arrange transport; do not call 9-1-1 in a non-emergency.
Remember that non-EMT or NEMT is non-emergency transport.
For routine care, call up to 1 month and at least 3 days in advance. Same day rides are subject to availability.
Rides (also called "trips") are limited to 75 miles, one-way, and up to four one-way trips per day.
Covered ambulance services, whether for an emergency or non-emergency situation, include fixed wing, rotary wing, and ground ambulance services, to the nearest appropriate facility that can provide care only if they are furnished to a member whose medical condition is such that other means of transportation could endanger the person’s health or if authorized by the plan. If the covered ambulance services are not for an emergency situation, it should be documented that the member’s condition is such that other means of transportation could endanger the person’s health and that transportation by ambulance is medically required.
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For emergency situations, whether for accident/injury or serious illness, emergency medical services may be needed for hospital transport. A medical emergency occurs when a prudent layperson, with an average knowledge of health and medicine, believes that medical symptoms require immediate medical attention to prevent devastating illness, loss of life, loss of a limb, or loss of function of a limb. The medical symptoms may be significant illness, injury, severe pain (including any unexplained or uncontrolled chest pain), or a medical condition that is rapidly getting worse.
Covered ambulance services include fixed-wing (airplane), rotary-wing (helicopter), and ground (truck) ambulance services, to the nearest appropriate facility that can provide care. Emergency care is covered services that are rendered by a provider qualified to furnish emergency services and are needed to evaluate, treat, and/or stabilize an emergency medical condition.
Ambulance services are covered for those whose medical condition is such that other means of transportation could endanger the person’s health or is otherwise authorized by the plan. This is known as non-emergency medical transport (NEMT) and is only appropriate if it is documented that the member’s condition is such that other means of transportation could endanger the person’s health and that transportation by ambulance is medically required.
*Note that emergency medical services do not transport anywhere other than hospitals and, in some cases, freestanding emergency departments.
Also note that family is generally not permitted to accompany loved ones in an ambulance unless the transport is a minor (aged 17 or younger).
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