Ambulance Services
The Plan covers emergency ambulance services and transportation provided by a licensed ambulance service to the nearest hospital that offers emergency health services. Ambulance service by air is covered in an emergency if ground transportation is impossible, or would put your life or health in serious jeopardy. If special circumstances exist, UnitedHealthcare may pay benefits for emergency air transportation to a hospital that is not the closest facility to provide emergency health services.
The Plan also covers non-emergency transportation provided by a licensed professional ambulance (either ground or air ambulance as UnitedHealthcare determines appropriate) between facilities when the transport is:
  • From an out-of-network hospital to an in-network hospital.
  • To a hospital that provides a higher level of care that was not available at the original hospital.
  • To a more cost-effective acute care facility.
  • From an acute facility to a sub-acute setting.
Prior Authorization Requirement
In most cases, UnitedHealthcare will initiate and direct non-emergency ambulance transportation. For out-of-network benefits, if you are requesting non-emergency ambulance services (including any affiliated non-Emergency ground ambulance transport in conjunction with non-Emergency air ambulance transport), you must obtain prior authorization as soon as possible before transport.
If you fail to obtain prior authorization from UnitedHealthcare, benefits will be subject to a $400 penalty.