Air Ambulance Transport
The following guidelines apply to air ambulance services. These guidelines should be used only as a reference as actual eligible benefits are based on the specific plan provisions and/or exclusions.
Air ambulance transportation is a service provided by either helicopter or a fixed wing aircraft, specifically designed, equipped, and staffed for transporting the sick or injured. It does not include chartered or commercial air flights.
Air ambulance transport may be considered medically necessary when the following criteria are met:
• The medical condition was such that urgent and rapid transport was necessary to stabilize or preserve the patient’s life.
• Transport could not have been provided safely by ground ambulance due to great distances, traffic obstacles, or prolonged transport times which would endanger the patient’s health or the point of pick-up was inaccessible by ground transport.
• Transport was to the nearest acute care hospital equipped to provide the level of care required to treat the patient’s illness.
Air ambulance services are not covered for transport to a facility which is not an acute care hospital (i.e., nursing facility, physician’s office, patient’s home).
If it is determined that transport could have been appropriately provided by ground ambulance, benefit for the air ambulance service will be based on what the cost would have been for ground transport, if less costly, subject to policy limits for air and ground ambulance transportation.
General benefit information may be verified by faxing a request to 1-309-346-8265. The information will be returned by fax within twenty-four (24) working hours.
An insured may be liable for deductible, co-insurance, copayment amounts, usual and customary disallowed amounts, and/or non-covered services.