UNDERSTANDING HIGHMARK'S TRANSPORTATION BENEFITS

• Community Blue Medicare HMO, Community Blue Medicare PPO, Complete Blue PPO, and Freedom Blue PPO WV Distinct/Signature Members
• Transportation is available at a $0 copay when the trip is part of continued acute care after a discharge from the Emergency Room.  There is no trip number limit for transportation. Continued acute care includes providers for skilled nursing facilities, home health agencies, inpatient rehabilitation facilities and long-term care hospitals. Arrangements for the trip should be made through the servicing provider. 

• Security Blue HMO-POS, Freedom Blue PPO, and Freedom Blue PPO WV - Standard Members
• Routine transportation is available at a $0 copay for up to 24 one way trips.  The trip limit is waived if the trip is part of continued acute care after discharge from the Emergency Room. Routine Transportation is used for medical related purposes such as doctor visits; appointments for dental, vision, hearing and behavioral health services; and visits to pharmacies to pick up prescription drugs within a 50 mile limit.  Destinations must always be plan approved. To schedule and obtain prior authorization, member must call at least 48 hours in advance at 1-800-550-8722, Monday through Friday from 8am to 5pm.

Emergency: This type of ambulance transportation is used when the person’s condition appears life-threatening, their condition could worsen and become life-threatening on the way to hospital, moving the person could cause further harm, or if the person needs the skills or equipment used by paramedics or EMT.

• All Medicare Advantage Plans
• Emergency ambulance services are covered under all Highmark Medicare Advantage Plans.   Ambulance services include fixed wing (airplanes) rotary wing (helicopters) and ground ambulance services to the nearest appropriate facility that can provide care only if they are furnished to a member whose medical condition is such that other means of transportation could endanger the person’s health.  Typically a helicopter is used to move patient as quickly as possible across short distances and an airplane is used for longer distances.

• All Medicare Advantage Plans
• It is possible to use an ambulance for non-emergency services, if the member’s condition is such that other means of transportation could endanger the person’s health and that transportation by ambulance is medically required.  All non-emergency transportation by ambulance must be prior authorized.  Some examples of non-emergency medical transportation vehicles include: fully equipped ambulances (traveling without deploying lights and sirens), wheel chair vans, medical cars and shuttle busses.  Non-emergency ambulance services require a Physician Certification Statement (PCS). The member’s non-emergent ambulance provider is responsible for obtaining prior authorization.

Note: Ambulance Copays

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