By enrolling in the MedX AirOne Membership Program or as a permanent resident of Elko, Humboldt, Pershing, Lander, White Pine or Eureka Counties, via donations to the Northern Nevada EMS Consortium (NNEMSC), donations fund your MedX AirOne Membership Program.
Members agree as follows:
Membership applies to me, my spouse/partner, and dependent children under the age of 26 who live with us and are listed on the application (if applicable).
All services covered by this membership must be arranged through or authorized by MedX AirOne Communications Center
If I am transported by MedX AirOne, MedX AirOne will bill my insurance or other responsible third-party payer (collectively, “Insurance”)
MedX AirOne will accept the amount paid by my Insurance as payment in full if the amount is equal to or more than the MedX AirOne usual and customary charges for any emergent transport.
If payment is less, I agree, but not required, to assist as reasonable with MedX AirOne to pursue any additional and available charges through negotiations or otherwise with the third-party payer.
The membership fee paid or donated on my behalf constitutes prepayment for any deductible, copayment, or other out-of-pocket expense not covered by my insurance, so I will be relieved of any out of pocket expense following transport.
Subject to the foregoing, I acknowledge that I am responsible for payment for any ground ambulance services rendered to me
Any payment(s) sent to me by my insurance for a MedX AirOne air ambulance flight must be submitted to MedX AirOne within ten (10) days of receiving payment.
In the event I am transported by a MedX AirOne program, I hereby assign and transfer to MedX AirOne all benefits payable by Insurance to or for my benefit, or the benefit of my spouse or dependents that are named as enrollees on my membership, for any services rendered
Membership covers medically necessary/emergent air medical transports completed by MedX AirOne, to the closest appropriate hospital. The sending Physician determines medical necessity not the third-party payer. Concerning scene response, scene response is deemed medically necessary/emergent and is therefore covered by the membership.
The MedX AirOne Program only applies to emergent transports and does not apply to any pre-scheduled transport or non-emergent transport for personal reasons.
I understand that under some circumstances, MedX AirOne may not be available to transport me. This may be due to weather conditions, maintenance, aircraft previously committed to another transport, FAA restrictions, governmental market restrictions or other factors
I understand that membership does not cover the cost of any transport rendered by other air or ground providers other than MedX AirOne.
Neither I, nor any family members are Medicaid enrollees. (Applicable to memberships purchased outside of previously stated county’s)
I understand that my MedX AirOne Program membership is not an insurance product. I certify that I am the individual applying/receiving a membership and am the legal representative of my spouse and dependent children and am duly authorized by them to execute this application and accept its terms and conditions on their behalf. The terms and conditions may be changed by the Company from time to time.