| NorthStar EMS 1701 E. Beebe-Capps Expy Searcy, Arkansas 72143 Business Office Phone 501-305-2287 Toll Free Phone 1-866-305-2287 Searcy * Beebe * Heber Springs * Bald Knob * Quitman |
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NorthStar EMS offers Individual and Family Memberships. Family memberships include head
of household, spouse, and unmarried children under age 22 still living at home or under 24 if
full time students. Membership purchase affirms that you have read, understand and agree
This is NOT an insurance policy or supplement.
Membership fees are nonrefundable / nontransferable. Annual enrollment drives are
conducted April 1 - May 31. All White & Cleburne County memberships expire May 31st. Fees
are not prorated when joining outside the enrollment period, and such memberships will
expire on May 31 of the membership year.
MEDICAL NECESSITY
Ambulance service must be medically necessary, usually as determined by a physician.
NorthStar EMS reserves the right to determine medical necessity for non-emergency service.
Emergency transports are limited to situations in which a member has sustained injury,
sudden illness or trauma and the need for the immediate medical attention of a doctor at a
hospital emergency room exists. Non-emergency transportation excludes such immediate, life
threatening needs and may require physician authorization and/or a Physician Certification
Statement (PCS) form as a condition of transport.
COVERAGE
Ambulance transportation (emergency & non-emergency) is provided to and from
HOSPITALS within NorthStar’s service area. Patients are transported to the hospital of their
choice; however, the physician or NorthStar EMS may select an appropriate facility based on
the patient’s medical condition. Emergencies and the need to provide continuing service area
coverage have first priority. All dispatching/staffing decisions are the sole right of NorthStar
EMS. Non-emergency services to and from medical facilities other than hospitals (e.g. doctor’
s office, clinics, dentist, freestanding dialysis, physical therapy, rehab) require medical
necessity and are subject to the member discount privileges below.
“MEMBER’S CHOICE” / OTHER PROVIDERS
Membership benefits are not guaranteed unless ambulance service is provided by NorthStar
EMS. To receive membership benefits, you may have to specify that NorthStar EMS be
called. In some areas, there are other ambulance providers, which may be automatically
dispatched unless you request NorthStar EMS. Members are encouraged to make the
dispatcher and others arranging ambulance transportation aware of their membership
benefits and to specify NorthStar EMS for transport.
MEMBER PAYMENTS / MEMBER DISCOUNTS !Important!
Membership DOES NOT guarantee no out-of-pocket expense for ambulance service. Where
benefits are available, NorthStar EMS will accept the amount paid as payment in full. When
there is NO medical, health insurance or other benefits plan which pays for ambulance
service, the member will receive a discounted ambulance bill [40% off the total charges] and
shall be responsible for payment directly to NorthStar EMS. NorthStar EMS agrees to pursue
all payer sources prior to billing the member the discounted rate. The discounted rate may
apply transports even if physician authorized.
ASSIGNMENT / THIRD PARTY REIMBURSEMENT
Members assign to NorthStar EMS all rights and benefits under any and all medical or health
insurance policies or plans and all other medical benefits programs or plans which provide
ambulance coverage. Further, members authorize holders of any information about them to
release it to HCFA, its Carriers or agents, and to NorthStar EMS now or in the future. Any
payments made directly to the member must be turned over to NorthStar EMS in full,
immediately. Failure to provide necessary information concerning available insurance or
medical benefits, or failure to forward any amount paid for ambulance service shall result in
revocation of membership. NorthStar EMS will file with all available policies or plans its claim
for each ambulance service, and further agrees to accept the amount paid as payment in full
up to the amount of the charges.
NEW GUIDELINES
Many skilled nursing facilities are subject to Consolidated Billing and Prospective Payment
System (CB/PPS) guidelines imposed by HCFA and the Federal government. Membership
with NorthStar EMS does not exclude any facility where a member may reside from payment
under the CB/PPS guidelines. Membership is not transferable to contracts with facilities
without prior authorization by NorthStar EMS.
Notice to persons with only MEDICAID coverage: Joining a membership program is voluntary
and is discouraged. You already have all benefits for covered services.
of household, spouse, and unmarried children under age 22 still living at home or under 24 if
full time students. Membership purchase affirms that you have read, understand and agree
This is NOT an insurance policy or supplement.
Membership fees are nonrefundable / nontransferable. Annual enrollment drives are
conducted April 1 - May 31. All White & Cleburne County memberships expire May 31st. Fees
are not prorated when joining outside the enrollment period, and such memberships will
expire on May 31 of the membership year.
MEDICAL NECESSITY
Ambulance service must be medically necessary, usually as determined by a physician.
NorthStar EMS reserves the right to determine medical necessity for non-emergency service.
Emergency transports are limited to situations in which a member has sustained injury,
sudden illness or trauma and the need for the immediate medical attention of a doctor at a
hospital emergency room exists. Non-emergency transportation excludes such immediate, life
threatening needs and may require physician authorization and/or a Physician Certification
Statement (PCS) form as a condition of transport.
COVERAGE
Ambulance transportation (emergency & non-emergency) is provided to and from
HOSPITALS within NorthStar’s service area. Patients are transported to the hospital of their
choice; however, the physician or NorthStar EMS may select an appropriate facility based on
the patient’s medical condition. Emergencies and the need to provide continuing service area
coverage have first priority. All dispatching/staffing decisions are the sole right of NorthStar
EMS. Non-emergency services to and from medical facilities other than hospitals (e.g. doctor’
s office, clinics, dentist, freestanding dialysis, physical therapy, rehab) require medical
necessity and are subject to the member discount privileges below.
“MEMBER’S CHOICE” / OTHER PROVIDERS
Membership benefits are not guaranteed unless ambulance service is provided by NorthStar
EMS. To receive membership benefits, you may have to specify that NorthStar EMS be
called. In some areas, there are other ambulance providers, which may be automatically
dispatched unless you request NorthStar EMS. Members are encouraged to make the
dispatcher and others arranging ambulance transportation aware of their membership
benefits and to specify NorthStar EMS for transport.
MEMBER PAYMENTS / MEMBER DISCOUNTS !Important!
Membership DOES NOT guarantee no out-of-pocket expense for ambulance service. Where
benefits are available, NorthStar EMS will accept the amount paid as payment in full. When
there is NO medical, health insurance or other benefits plan which pays for ambulance
service, the member will receive a discounted ambulance bill [40% off the total charges] and
shall be responsible for payment directly to NorthStar EMS. NorthStar EMS agrees to pursue
all payer sources prior to billing the member the discounted rate. The discounted rate may
apply transports even if physician authorized.
ASSIGNMENT / THIRD PARTY REIMBURSEMENT
Members assign to NorthStar EMS all rights and benefits under any and all medical or health
insurance policies or plans and all other medical benefits programs or plans which provide
ambulance coverage. Further, members authorize holders of any information about them to
release it to HCFA, its Carriers or agents, and to NorthStar EMS now or in the future. Any
payments made directly to the member must be turned over to NorthStar EMS in full,
immediately. Failure to provide necessary information concerning available insurance or
medical benefits, or failure to forward any amount paid for ambulance service shall result in
revocation of membership. NorthStar EMS will file with all available policies or plans its claim
for each ambulance service, and further agrees to accept the amount paid as payment in full
up to the amount of the charges.
NEW GUIDELINES
Many skilled nursing facilities are subject to Consolidated Billing and Prospective Payment
System (CB/PPS) guidelines imposed by HCFA and the Federal government. Membership
with NorthStar EMS does not exclude any facility where a member may reside from payment
under the CB/PPS guidelines. Membership is not transferable to contracts with facilities
without prior authorization by NorthStar EMS.
Notice to persons with only MEDICAID coverage: Joining a membership program is voluntary
and is discouraged. You already have all benefits for covered services.