IN AN EMERGENCY THE LAST THING YOU SHOULD WORRY ABOUNT IS PAYING FOR THE AMBULANCE….
Emergencies Happen – An ambulance transport can cost more than $1,500. Most insurance providers, including Medicare do not cover the entire portion of the ambulance bill. You can help both yourself and our organization by participating in our subscription drive.
As a subscription member, you will not be billed for balances owed on services that are partly covered by your insurance carrier including insurance copays and deductibles, with the exception of deductibles as mandated by Federal Law. On non-covered services such as non-emergency transports, advanced and basic life support assessments you will receive a 25% discounted rate.
Your subscription is used to purchase ambulances, equipment and medical supplies, and to provide training to our providers.
Subscription plans are valid from February 28, 2013 through February 28, 2014. There is no “pro-ration” for those who wait to subscribe, so the sooner you sign up, the greater the benefit.
$30 Individual – covers only the individual subscription holder.
$50 Couple – cover the subscription holder & spouse listed on this form.
$70 Household – covers the subscription holder, spouse, co-inhabits of a single residence (up to six people).
We also encourage you also to subscribe to your local basic life support ambulance service, if you are serviced by one.
Pike County ALS has billing agreements with over a dozen local BLS services in Pike and Wayne Counties. If the Basic Life Support service transports you to the hospital and patient billing falls under one of these agreements the billing will be processed under the agreement with the BLS service.
Payment Liabilities Not Covered Under the Subscription:
Insurance pays for ambulance transportation in accordance with the terms of your policy. In certain situations, a subscriber may be financially responsible for payment for ambulance transportation that is non-covered by your insurance and you may not be advised of this non-coverage at the time of your transport. This plan does not include instances in which you are a patient covered under Medicare and your local basic life support ambulance is the transporting service. In cases where the transport is not medically necessary, you are uninsured, or where you were able to take another form of transportation, you will be financially responsible for the charges imposed by PCALS, less a 25% discount.
Important Insurance Information:
Usually, PCALS will try to directly bill your insurance company using a third party billing service. In consideration and payment of the membership fee: you assign to PCALS. all ambulance benefits that I that I (or any covered family member) may otherwise be entitled to receive from any insurance or other third-party payor for services provided under my PCALS membership, now or in the future. Failure to comply would be fraudulent under our subscription agreement and consequently void your subscription benefits. This program is
not an insurance product and this is not an offer for the sale of an insurance policy. Subscription membership is not applicable to Medical Assistance (Medicaid) recipients.
Click the link to view our 2013-2014 Subscription Drive Letter.
Mail it back to us with payment to enroll.
If you have any questions about our ambulance subscription program, please contact us at email@example.com or (855) PIKE-ALS.