FAQ's

• Patient’s Name
• Social Security Number**
• Date of Birth
• Type of Insurance
• Policy Number
• Mode of Transport Requested
• Origin Address
• Destination Address
• Doctor’s Names, Suite Number, & Phone Number

**Insurance Carriers and Medicare require the Patient’s Social Security Number and Policy Number(s) for identification and to process the claim.

Coverage for the mode of transportation requested is determined by the medical needs of the patient. Medicare and other insurance providers state that non-emergency ambulance transports are considered medically necessary when all other forms of transportation (e.g. private car, taxi, or wheelchair van) are contraindicated, which may affect the patient’s health or safety. The lack of an available alternate mode of transportation (e.g., taxi, bus,personal car) or the inability to drive does not satisfy the medical necessity requirements. Non-emergency ambulance transport for convenience or because another means of transportation are not available is not considered medically necessary, and therefore not covered.

If requesting non-emergent Ambulance transportation our patient advocate will have a list of questions which can include the following:

• Is the patient “Bed Confined”? This means the patient is unable to get up from bed without assistance, unable to ambulate, and unable to sit in a chair or wheelchair?
• Does the patient have non-healed fractures?
• Are all other modes of transportation contraindicated that it will adversely affect the patient’s health or safety?
• Does the patient have isolation requirements?
• Is the patient confused?
• Can the patient be transported unsupervised?
• Is the patient a harm to themselves or others?
• Does the patient require oxygen and unable to self-administer?
• Is cardiac monitoring required while en route?
• Is the patient unable to sit due to decubitus ulcers or other wounds?

**Please see our PCS form located on our “Authorization” page for more details.

If the patient is ambulatory or can remain safely seated in a wheelchair during transport, transportation OTHER than an ambulance should be utilized.

In cases of emergencies, ambulances are ALWAYS utilized.

SuperiorCare Ambulance can transport you to your hospital of choice if you are stable enough for the transport, which is determined by the Medical professionals present at the time of the assessment.

An emergency transport is 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

In these cases, SuperiorCare would respond immediately, meaning our EMS professionals would begin as quickly as possible taking the steps necessary to respond to the call. Non-emergency transports are often scheduled in advance and typically require prior authorization by the patient’s insurance provider before transportation occurs.

What are the levels of care in EMS?

The different levels of care are determined by the type of care that can be given to a patient by the EMS professional the time of transport. Common levels include: Basic Life Support (BLS), Advanced Life Support (ALS), Mobile Intensive Care (MICU), and Critical Care.

Basic Life Support

A Basic Life Support (BLS) ambulance is staffed by two Emergency Medical Technicians (EMTs) who have training in basic emergency medical care such as basic airway management, use of an automated external defibrillator (AED) and basic drug administration. Examples of BLS transports include:

• Hospital discharges with basic caregiving
• Psychiatric discharges
• Basic Life Support emergencies such as lower extremity fractures
• Inter-facility transfers
• Transport to dialysis / wound care
• Doctor’s offices

Advanced Life Support

Advanced Life Support (ALS) ambulances meet all the BLS level requirements in addition to:

• Staffing a paramedic with 1,000 hours of education and training
• Advanced airway management
• Drug administration
• Cardiac monitoring

Patients who typically require ALS transport include:

• Medical/surgical patients with a continuous IV
• Patients on a cardiac monitor
• Patients with potential airway compromise
• Any patient deemed to have a potential complication during transport when reported by the sending facility
• Life threatening medical emergencies (i.e. respiratory distress, stroke, seizure, or chest pains)
• Multi-trauma or burn patients

Mobile Intensive Care Unit

Mobile Intensive Care Units (MICU) meet all the ALS level requirements, as well as the ability to administer narcotics, provide ventilation to patients, and provide life supporting measures to severely injured/highly acuity patients during transport to/from a medical facility for continuous care.

If prior authorization for an ambulance transport is on file, a 24 hour notice is appreciated. However, if prior authorization is not on file, then 48-72 hour notice is needed. Same-day requests are considered, only if availability exists.

Medicare deems the following origins/destinations as covered locations for ambulance transportation assuming medical necessity exists:

• Residence to/from Hospital or Nursing Home
• Dialysis centers
• Hospitals
• Nursing Homes
• Wound Care centers

Doctor appointments are not covered under Medicare, but a need based insurance such as Medicaid, will cover as long as authorization is granted.

Yes, as a patient you have the right to use whomever you prefer for your transportation needs. While hospital case managers coordinate ambulance transportation, you as the patient can ask your case manager to request transportation from your preferred ambulance service.

SuperiorCare can transport you for dialysis, as long as your insurance policy lists transportation services as a covered benefit and it is medical necessary, both have to be confirmed before transport occurs. With managed care in full effect, approval is recognized by a Prior Authorization Number (PAN). At SuperiorCare, we understand the needs of dialysis patients because we transport many patients each week. We look forward to the opportunity to serve you.

In most cases, Medicare & Managed Medicare Segments will pay 80% of a provider’s allowable rate. The remaining 20% is the responsibility of the secondary insurance and/or the patient. This is commonly known as the co-payment. These rates/percentages can still vary due to a patient’s deductible. Please contact your insurance provider for specific coverage details/limits.

It is always a great idea to contact your insurance provider to see what type of transportation eligibility you are covered for. If you have Medicaid or a managed care plan (i.e. Amerigroup, Molina, or Superior Health Plans), you must obtain a Prior Authorization Number (PAN) before we can schedule transportation–unless your transport is a medical emergency going into an emergency room. The prior authorization forms for the Managed Care Plans can be downloaded from our website under the “Authorization” tab.

You, as a patient, are required to provide signatures on our Patient Care Report (PCR) acknowledging consent for treatment and transportation. If you do not have the mental or physical capacity to sign the document, then a legal guardian may do so. With this signature, SuperiorCare Ambulance is authorized to submit a bill on your behalf, assign benefits to SuperiorCare allowing your medical insurance carrier to pay us directly, and acknowledge you have received SuperiorCare’ s Privacy Practices Notice.

We cannot submit a claim to a medical insurance carrier without a signed authorization from the patient or guardian. Failure to provide a signed authorization of the patient may require SuperiorCare to seek payment directly from the patient or guarantor.

To comply with applicable laws, requests for medical records must be made in writing. In certain cases documentation and signature authorization are needed

A medical power of attorney gives specific instructions, prepared in advance, that are intended to direct medical care for an individual if he or she becomes unable to do so in the future.

No. In the state of Texas, Gurney cars are illegal to transport patients. At the minimum, if a patient requires transportation via stretcher/gurney then a Basic Life Support (BLS) ambulance must be utilized to safely transport a patient to their destination or appropriate facility for care.

*Chapter 773 §§ 773.004, 773.041: http://www.statutes.legis.state.tx.us/Docs/HS/htm/HS.773.htm

According to Texas Department of State Health Services (DSHS), a do not resuscitate order (DNR) is a medical order written by a doctor that instructs health care providers not to initiate cardiopulmonary resuscitation (CPR) if breathing stops or if the heart stops beating. A DNR does not affect other treatments, such as the administration of pain medicines and/or nutritional supplements.

As a licensed EMS provider in the State of Texas, we can only honor a signed and dated Out-of-Hospital DNR.

Please click on the link for further information: http://www.dshs.state.tx.us/emstraumasystems/ruladopt.shtm