Terms & Conditions
Pafford EMS Family Membership
Membership Information | Terms & Conditions | Application
In consideration of my membership fee and assignment of medical benefits, Pafford agrees to provide emergency ambulance services to each covered person to all hospitals and skilled nursing facilities in the service area. Ambulance trips from a patient’s residence to a physician’s office are NOT covered along with ambulance services for dialysis patients who are subject to prior approval for ambulance transport based on the initial assessment for the patient per Medicare requirements.
I am financially responsible for payment of Pafford charges for services provided to a covered person. I hereby assign all ambulance service insurance benefits for each covered person to Pafford. I understand that Pafford will file my ambulance insurance claim for me and will collect payment for itself using all of my health insurance policies, plans or programs up to the amount of Pafford’s charges to the covered person. Any insurance payment I receive related to Pafford’s services will be immediately delivered to Pafford. I request that payment of Authorized Medicare benefits be made on my behalf to Pafford for any ambulance services provided to me by Pafford. If I do not have insurance or if for any reason my insurance denies, I understand that I am financially responsible for 50% of the amount charged by Pafford.
Valid only for medically necessary air ambulance transports on Pafford Air One Alpha, Air One Delta, Air Med or Air Wing. DOES NOT include air ambulance transports on Air One Bravo or any other air ambulance provider.
I authorize any holder of medical information or documentation about me to release to the Health Care Financing Administration and its agents and carriers, as well as to Pafford, any information or documentation needed to determine these benefits or benefits payable for related services or any services provided to me by Pafford now or in the future.
I understand this is a voluntary contribution and that if unable to purchase a membership, that it will not affects my ability to receive an ambulance service to the nearest medical facility.