Terms and Conditions
Millicreek Paramedic Service Membership - Terms and Conditions
As a member of Millcreek Paramedic Service, I understand that I will request that payment of authorized Medicare/insurance benefits be made on my behalf to Millcreek Paramedic Service for any services furnished to me by Millcreek Paramedic Service. I will authorize any holder of medical information about me to release to the Health Care Financing Administration and its agents and carriers as well as to Millcreek Paramedic Service, any information needed to determine these benefits or benefits payable for related services or any services provided to me by Millcreek Paramedic Service now and in the future. I will authorize payment for these benefits to be made directly to Millcreek Paramedic Service. I will agree to pay immediately to Millcreek Paramedic Service, all payments sent directly to me from either the insurance company or other medical benefit providers.
I understand that while the patient is responsible for payment for services, my Millcreek Paramedic Service membership fee will cover my deductibles or copayments. I will cooperate in any way with claim submission to my medical benefit providers and to provide any correspondence regarding my claim(s) to MPS, if requested.
I understand that “Family Membership” includes everyone who is claimed on my family’s head of household tax return.
I understand that my MPS membership also includes medically necessary, non-emergency stretcher ambulance transportation within a 150-mile radius of Millcreek Township. Wheelchair patient transportation is provided to members confined to a wheelchair for medical appointments at $20 per one-way trip within Erie County. (Additional charge for mileage applies outside of Erie County.) Twenty-four hour advance scheduling and physician authorization of medical necessity is required for all non-emergency services.
MPS reserves the right to change scheduled transports due to emergency requirements. An MPS membership is non-transferable and non-refundable. An MPS membership fee is not tax deductible as a charitable contribution, but may be eligible as an itemized medical deduction. An MPS membership is not an insurance policy. I understand that my 2007-2008 MPS membership is valid through November 30, 2008. This program is not applicable to Medical Assistance beneficiaries.
Membership is not a contract for provision of services at any specific time and, as with any ambulance company, services are subject to availability. Service may be subject to modification without prior notice.