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Blank Member Appeals by Insurance Company



Records Request, DOR, and PHI Authorization Forms

    Your insurance company typically does not pay the full amount of the bill for air medical transport. This leaves you owing a large amount for the balance of the bill. Apollo’s membership service covers the gap between your current health insurance coverage and the bill, so you will pay no additional fees for an emergency air medical transport provided by Apollo. If you are a member with insurance, you don’t get billed for that balance. We will bill your insurance carrier and accept its payment as payment in full. That means zero out-of-pocket expenses for you, as a member of Apollo’s membership service. Apollo will work to bill and collect from private or third party insurance on behalf of the member. Peace of mind during and after an emergency is not only important to you, it’s important to us. In the event that you or your loved ones should require a non-emergent transport to a distant facility, Apollo will work to get the transport pre-approved and covered prior to transport. If you are a member and a private or third party insurance deems transport usage not medically necessary or denies claim for any reason, Apollo will appeal the denial and re-file the claim on your behalf. Our membership and billing staff work closely together so that in most cases there is no action needed on your part. Everyone who lives in the household and is listed on the application is covered under the membership plan. Dependent children attending college who maintain the household as their primary residence are covered because they are dependent on the parents to pay their college costs. Medicaid recipients are not eligible for the Apollo MedFlight Membership Program due to State restrictions.
    Membership services can be used an unlimited number of times for air medical transports as needed within the membership period. Membership plans are applied to all members of your household who maintain the same permanent address. And there is no age limit of any kind. When the need arises and you or your loved one requires an emergency transfer to a hospital providing specialty services, Apollo can assist your physician in finding an appropriate receiving facility and physician. This allows your physician and the hospital staff to continue to focus on you and the care you need.
    Apollo MedFlight offers 24-hour emergency and non-emergency medical transport services. Apollo works with physicians, hospitals, EMS services, nurses, paramedics and your insurance company to expedite your care. Apollo coordinates all ground transportation services required and you or your loved one is accompanied bedside to bedside by our medical flight team. All Apollo MedFlight aircraft are equipped similarly to a hospital ICU/CCU. Your loved one will be cared for with the same medical equipment and medical expertise as they would on the ground. When the need arises and you or your loved one requires an emergency transfer to a hospital providing specialty services, Apollo can assist your physician in finding an appropriate receiving facility and physician. This allows your physician and the hospital staff to continue to focus on you and the care you need.
    • To provide comprehensive air ambulance services. • To handle the details of the flight so you may focus on your loved one or patient. • To coordinate the appropriate professionals in medicine, aviation and insurance to achieve a successful mission.
    In consideration of the payment by the Member of the membership fee, Apollo MedFlight LLC (“Apollo”) agrees to provide the following benefits, subject to the terms and conditions specified herein: “Members” shall include the individual who signed the Application (“Primary Member”) and all household members listed in the Ap­plication, so long as such individuals reside at the same address as the Primary Member. However, under state law, Medicaid benefi­ciaries are not eligible for membership. The applicant(s) represent that they are not Medicaid beneficiaries. The membership fee constitutes prepayment by the Member of all deductible, copayment and other charges which are not paid by the Member’s health insurance or other third party sources such as a homeowners or automobile policy (collectively, “Insurance”) for Covered Transports, as defined herein. Apollo shall accept the amounts paid by the Member’s Insurance as payment in full for such transports. Subject to the foregoing, the Member is finan­cially responsible for all costs of air ambulance services, up to the amount that would be paid by insurance for a medically necessary transport. “Covered Transports” include only medically necessary air am­bulance services provided by Apollo to the closest appropriate hospital. Air ambulance transports which are determined by the Member’s primary Insurance not to be medically necessary are not Covered Transports. The Member is responsible for all Apollo charges for air medical services that are not Covered Transports. Membership only covers transports provided by Apollo. Transports provided by other air medical providers or by ground providers are not covered. Apollo may not be available when requested due to factors beyond Apollo’s control. For example, Apollo’s aircraft may be occupied providing transports to other patients, or Apollo may be unable to respond due to weather conditions, maintenance requirements, governmental market restrictions or other factors. Fur­ther, Apollo does not operate in all areas. As a condition of receiving membership benefits, the Member as­signs and transfers to Apollo all rights and benefits that the Member has under any and all Insurance, including but not limited to auto or homeowner’s insurance policies. The Member authorizes pay­ment of all such benefits for air ambulance services to Apollo. In the event payment is made to the Member or any other party on the Member’s behalf, the Member agrees to remit all such amounts promptly to Apollo. As requested by Apollo, Member will assist Apollo in the collection of claims made on Insurance. Apollo is not an insurance company and the Membership is not an insurance policy. Membership shall become effective three days after Apollo receives a com­plete application with full payment. Memberships are nonrefund­able and nontransferable. The Member agrees to inform Apollo within ten (10) days of any change in the Member’s health insur­ance status (e.g., loss of coverage) or any change in the household Members covered by this membership. I HAVE READ AND UNDERSTAND THE TERMS AND CONDITIONS OF THE APOLLO MEDFLIGHT MEMBERSHIP PROGRAM AND AGREE TO ABIDE BY ITS TERMS AND UNDERSTAND THAT THESE TERMS AND CONDITIONS SUPERSEDE ALL OTHER WRITINGS DOCU­MENTS AND DISCUSSIONS RELATING TO MEMBERSHIP.



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(844) 838-7994


(888) 978-5029

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