A Household Membership provides benefits to you and your family members who live at your private residence, although your membership will extend coverage to any related family member or guest in your home at the time of service. Your Membership will be effective upon receipt of your credit card payment, and expire 12/31/19. Please read the Terms of Membership below and contact Citizens' Ambulance Service if you have any questions.
TERMS OF MEMBERSHIP
Provisions for Service for Subscribing Members: Citizens’ Ambulance Service Inc. (Citizens’) will provide emergency and non-emergency ambulance service for members when medically necessary through December 31, 2019. For membership benefits to apply, either point of origin or point of destination of the ambulance trip must be in Citizens’ designated service area. A physician’s certification may be requested (required by an insurance carrier) to confirm the medical necessity for an ambulance transport at the time of transport, although medical certification may not always be available to Citizens’ prior to the use of the ambulance. This membership authorizes Citizens’ to bill and receive payment from your primary insurance and any other insurance carriers when there is a properly completed assignment of your insurance benefits to Citizens’. If your insurance plan pays benefits directly to you, it is your responsibility to forward all payments to Citizens’.
Citizens’ Transport Service: Citizens’ Ambulance Service Inc. offers medical van transportation to and from medical appointments when an ambulance is not medically necessary. The service utilizes wheel chair accessible vans and is available for an additional fee per transport; members of Citizens’ Ambulance Service will receive priority scheduling whenever possible.
Annual Membership Fee: The annual membership fee for Citizens’ Ambulance limits your financial responsibility by covering half (50%) of the uninsured portion of all local emergency ambulance services provided by Citizens’. This pertains to medically necessary ambulance trips within the subscription service area for you or a dependent household member, although your membership will extend coverage to any related family member or guest in your home at the time of service.
Accepting Membership: By applying for membership, you authorize any holder of medical, or other information needed for the processing of any claim for services rendered by Citizens’ to release such information to Citizens’ and permit a copy of this authorization to be used in place of the original. Membership is non-transferable, non-refundable and takes effect immediately upon acceptance of the membership application by Citizens’.
Subject to Availability: Membership is not a contract for the provision of emergency or non-emergency services at any specific time and all services are subject to availability.
Not an Insurance Policy: This program is not an insurance product and is not an offer for the sale of an insurance policy. You must comply with the terms and conditions of your insurance company for medical transportation. We urge you to call us to discuss your non-emergency transportation needs and review your coverage to avoid unexpected out-of-pocket costs.
Medicaid Beneficiary: If you are covered by a Medicaid Insurance product your membership benefits are limited to the discounts offered (if available) to members who use Citizens’ Transport Service. Current billing policies apply.
The following services are not covered by this subscription and are subject to Citizens’ current billing policies:
- Ambulance services rendered that do not meet your insurance company’s definition of medical necessity or insurance pre-authorization.
- Any charges related to long distance ambulance services or other non-covered services, which are based solely on patient and/or physician preference.
- Lift Assist only, patient not transported
- Medical Response only, patient not transported
If you would like to request a copy of Citizens’ Privacy Notice or if you do not want to receive future communications, you can call Citizens’ Office at 724-349-5511 or 1-800-655-2343.
The terms of this subscription membership program may change without prior notice.