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Services Guide &
Claims Instructions
After a member has experienced an Emergency Ground or Air Transport/Evacuation, Employee Member Solutions will step in and help resolve Member's out-of-pocket costs in accordance with the Member Service Contract.
When a Member requires non-emergency services provided by Employee Member Solutions following an Emergency Ground or Air Transport/Evacuation, the Member should contact Employee Member Solutions directly to help assist with resolving the out-of-pocket costs associated with a Visitor Transportation, Accident Site Towing Services, Funeral Assist Services, and Home Health Services.
Please refer to your Member Service Contract for the applicable terms & conditions.
Instructions for
New Claims
- Provide the ambulance service bill to Employee Member Solutions
- Submit the bill via email or direct mail (details below).
- Include the Explanation of Benefits (EOB) and provider run/trip notes
- For inquiries, contact the EMS' claims department at 929-367-8326.
Necessary Documents
for Claims Processing
via EMS
- Bill or Health Insurance Claim Form (HICFA).
- Provider transport notes or trip/run notes.
- Explanation of Benefits (EOB)
- Death Certificate (if applicable)
- Written attestation from their attending Physician (if applicable)
Home Health Services
Following Member's discharge from a medical facility resulting from an Emergency Transport, Members who cannot perform 2 or more activities of daily living (ADL's) are eligible for up to 100 Hours of Home Health Care Services.
Member must provide a written attestation from their Physician confirming their inability to perform 2 or more ADL's.
Member must contact EMS or its third party provider for coordination of the Home Health Service. EMS will provide further instructions if a third party provider issues these services directly.
Automobile Accident
Site Towing
Following an automobile accident that results in a medically necessary emergency transport the Member should contact EMS prior to Member paying any fees for tow service providers that transport their vehicle. The Member or Member's family member should contact EMS to help mitigate the out-of-pocket costs associated with towing their vehicle from the accident site.
Final Expense -
Funeral Support
After the death of a Member, and prior to a Member paying the expenses associated with a funeral the Member or Member's family member should contact EMS to help mitigate the out-of-pocket costs incurred as the result of a funeral for Member.
Visitor Transportation to Member Location
When a Member is injured more than 150 Miles from the home, Member, or Member's companion should contact EMS prior to purchasing travel to and/or from the Member's location.
EMS will then coordinate the travel to where the Member is being treated.
Member must also provide a written attestation from their attending Physician confirming that the Member be hospitalized for over seven days.
Reference
- Member should contact EMS prior to coordinating any non-emergency services.
- See Member Services Contract for the applicable terms and conditions.
