Membership Description & Agreement

Primary Care is an ambulance subscription program sponsored by Bartlesville Ambulance Service (BAS). Primary Care provides for the prepayment of the co-payments and deductibles for all medically necessary ambulance services for which the patient has financial responsibility. Primary Care also provides a reduced fee for non-emergency transports that are not covered by insurance or Medicare. Primary Care is not an insurance policy or supplement. Membership is good through May 31, 2018

Who is Covered:

One Primary Care membership covers an individual for $66.00 per year. If there are two or more family members (a spouse and any children under the age of 21), their member ship will cost $78.00 a year. A spouse being cared for in a nursing home may be covered under family membership.

Excluded Services:

Primary Care members must present a complete certificate of medical necessity to receive benefits for a non-emergency transports. Primary Care provides no coverage for non-emergency transports without a certificate of medical necessity. Certificates must be completed by the patient’s physician. transports to the doctor’s office, dentist office, physical therapy centers and pharmacies are NOT covered by Primary Care.

Membership Benefits:

Primary Care membership benefits are applied to emergency transports and non-emergency ambulance transports in Bartlesville Ambulance service area. BAS service are includes a 20 mile radius.

Emergency transports are fully covered. An emergency is defined as an unforeseen medical condition that requires urgent and nonscheduled medical attention.

Non-emergency transports are fully covered if Medicare or Insurance provides benefits for the transport. If Medicare, Insurance, or any other 3rd party payor denies benefits for a non-emergency transport, the Primary Care member will receive a 40% discount off the standard non-emergency fee. A physician will have to sign the Medical Necessity Certificate for non-emergency transport to be considered for benefits. If the physician states the ambulance is not medically necessary, members can receive a $5.00 discount from our Wheel Chair Service.

Agreement

I acknowledge that my insurance provider or I are responsible for payment of ambulance service provided to my be Bartlesville Ambulance. In consideration and payment of the membership fee, I hereby assign to Bartlesville Ambulance all benefits 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 Primary Care membership. Bartlesville Ambulance will accept this assignment as payment in full for emergency ground transport if insurance or other third-party payor coverage provides benefits for the transport. I understand Bartlesville Ambulance will file my ambulance insurance claims for each covered person and is entitled to receive payment for all insurance, Medicare or other third-party payor up to the amount of Bartlesville Ambulance’s usual charges. For non-emergency services, a Physician’s Certification Statement must be signed by the patient’s Physician. If the Physician sates the ambulance was not medically necessary¬† and the Patient or Family wants ambulance transport, Primary Care Members will be billed 60% of the standard non-emergency charge. For Primary Care Member not qualifying for non-emergency ambulance transport, a Wheel Chair Service is available with a $5.00 reduction from the standard Wheel Chair Transport charge. Any Medicare, Insurance or other third-party payment I receive related to Bartlesville Ambulance’s services I will immediately deliver to Bartlesville Ambulance. I also understand that Bartlesville Ambulance’s services area is 20 miles radius, that the Primary Care membership is only good in the service area.

Click Here To Sign Up For Primary Care