BlueCross BlueShield of Tennessee Administrative Services

TVA Ground Ambulance Transport Policy

Applies to TVA members only.

DESCRIPTION

This policy provides guidelines that are appropriate for the majority of individuals who need one-way ambulance transport greater than 100 miles in both emergency and non-emergency situations.  Unique clinical circumstances may justify individual consideration for coverage based on a review of applicable medical records.

GUIDELINE

ORIGINAL EFFECTIVE DATE:  5/26/2017

MOST RECENT REVIEW DATE: 5/26/2017

ID_THM_TVA_UM

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

This document has been classified as public information.