No. LifeCare is not insurance. It does not pay your hospital, doctor, or other medical bills. LifeCare is a membership program that helps you reduce or eliminate your out-of-pocket costs for deductibles and co-pays that your insurance does not pay for ambulance service provided by TRAA or another Allen County participating ambulance service. LifeCare also helps reduce the amount you have to pay for medically necessary ambulance service if you don’t have insurance, or if your insurance doesn’t cover ambulance service.
Yes. As a LifeCare member, TRAA (or the participating ambulance service providing your service) will bill your insurance for your medically necessary ambulance service. If you have a secondary insurance, like a Medicare supplement plan, TRAA (or the Allen County participating ambulance service providing your service) will also bill your secondary insurance. As long as your insurance company pays more than your membership fee amount, TRAA (or the Allen County participating ambulance service providing your service) will accept the insurance payment as “payment-in-full” and you will not owe any balance not paid by your insurance.
If you receive a check for ambulance service from your insurance company, you must turn that check over to TRAA (or the Allen County participating ambulance service providing your service) under the terms of the LifeCare agreement. If you do not, your LifeCare membership can be cancelled and you will be responsible for 100% of the ambulance bill.
Even in these cases, LifeCare can save you hundreds of dollars. Effective with 2015 memberships, TRAA (or the Allen County participating ambulance service providing your service) will bill you directly and give you a 40% credit on your medically necessary ambulance service bill. You will only owe 60% of the total bill. That 40% credit can save you $500 or more on one ambulance trip alone. The amount of the actual savings depends on the amount of the total bill.
For ambulance service to be covered by LifeCare, the service must be “medically necessary”. The term “medically necessary” is defined by federal healthcare programs as:
“Medical Necessity is established when the patient’s condition is such that the use of any other method of transportation would be hazardous to the patient’s health. This implies that alternative, less expensive forms of transportation should be used unless the health of the beneficiary would be at risk by so doing. If transportation other than an ambulance could be utilized without endangering the individual’s health, whether or not other transportation is actually available, no payment may be made for the ambulance service. Additionally, Medicare will not reimburse for ambulance transportation if the service planned for the patient at the destination could be provided as effectively and more economically at the patient’s location (e.g. nursing home, residence.)”
In other words, if you could go to the hospital by private car, taxi, bus, or some other form of transportation without endangering your health, then ambulance transportation would NOT be medically necessary and would not be covered by your LifeCare membership and most insurance policies. This is even the case if you don’t have a car or access to other transportation.”
For ambulance service to be considered medically necessary under the federal definition, the ambulance service must be able to reasonably prove that transportation by ambulance was necessary and that transportation by any other means would have been “hazardous” or detrimental to the patient’s health.
Basically, the ambulance service transporting you makes that initial decision. For Federal and State programs like Medicare and Medicaid, federal law makes it illegal for an ambulance service to bill Medicare or Medicaid for ambulance service that the ambulance service provider knows, or should have known, did not meet the government’s criteria for medical necessity. If the patient insists that the ambulance service bill Medicare, then the ambulance service is required by government regulations to use a code that notifies Medicare that the ambulance service believes that the service did not meet the medical necessity criteria.
No. LifeCare covers all medically necessary emergency transports and all medically necessary non-emergency transports as well.
No. For your medically necessary transport to be covered by LifeCare, the transport must be totally in Allen County. Transports that begin outside of Allen County, end outside of Allen County or are anytime leave Allen County are not covered by LifeCare.
Yes. In certain cases, TRAA will respond with an Allen county ambulance service to provide assessment capabilities or advanced level care that the county ambulance cannot provide. In these cases, TRAA and the participating ambulance service providing your initial service will both honor LifeCare. If you are transported on the county ambulance service’s ambulance with a TRAA paramedic providing care, TRAA’s bill will be covered at 100% if you are a LifeCare member.
LifeCare covers eligible services by the following ambulance providers: Three Rivers Ambulance Authority (TRAA), Aboite EMS, Hoagland EMS, Huntertown EMS, Monroeville EMS, Northeast EMS, Poe EMS, Southwest EMS, and Washington EMS. New Haven’s East Central Fire & EMS is not a participating provider and does not honor LifeCare; and TRAA does not honor their ambulance program.
The following items are NOT covered under your LifeCare membership.
That depends. If your condition is considered to be potentially life-threatening, local ordinance and medical protocols mandate that TRAA paramedics transport you to the nearest hospital capable of meeting the needs of your condition. In these cases, the term “nearest” means nearest in terms of shortest amount of transport time, not necessarily distance.
Some conditions may call for specialty care. For example, if you suffer a serious trauma injury, you may need to be taken to one of Allen County’s two trauma centers (Lutheran Hospital or Parkview Regional Medical Center), or if you suffer from certain specific heart conditions, you may need to be transported to a specific hospital with specialized cardiac facilities (Lutheran Hospital, Parkview Regional Medical Center, or St. Joseph’s Hospital). In these cases, we may be required to bypass the nearest hospital and take you to the nearest
“specialty” hospital.
If your condition is not considered to be potentially life-threatening, you will be taken to the hospital you specify. If you don’t have a preference, TRAA paramedics will take you to the nearest hospital.
No. LifeCare does not cover transportation to a residence. LifeCare only covers medically necessary ambulance transportation to a medical facility (except those specifically excluded above). LifeCare will cover your hospital release if ambulance transportation is medically necessary and you are being transported to a nursing home for continued care.
If you need an emergency ambulance, call 911. If you need to schedule a non-emergency ambulance transport, call 420-8722.
No. LifeCare does not need to be discussed in an emergency situation.You will receive the same high-quality care whether you are a LifeCare member or not. The medical staff are there to assist the patient first and foremost. Our billing department has your name and information provided on your membership application in our billing software database. The software will recognize you as a LifeCare member when the billing staff enters your information for billing purposes.
All residents of Fort Wayne and most residents of Allen County, Indiana are eligible to join. Residents of a small portion of Eel River Township are NOT eligible and Medicaid recipients are NOT eligible. If you are not sure, you can call 422-9172 and someone will help you determine your eligibility.
LifeCare costs only $75 per household each year.
A household is considered a single individual, a husband and wife, or a husband and wife and any
dependent children under the age of 21 (26 if a full-time college student living at home).
If you are not married, and if you cannot claim him or her as a dependent on your federal income tax, then they cannot be on your membership. They must purchase their own membership.
Yes. We understand that things occur that may force a spouse to live in a care center. As long as you are legally married, you and your spouse can be on the same family membership.
No. TRAA’s LifeCare program is not affiliated with any other membership program. TRAA’s LifeCare program has been in existence since 1983. Don’t be fooled by others that look like TRAA’s LifeCare program. Make sure you read any membership program information carefully before you sign up to make sure it is TRAA’s LifeCare program, not someone else’s.
TRAA is not the primary ambulance service for these areas. If you call 911 for ambulance service in these areas, you will get East Central Fire & EMS as the primary or ALS backup coverage. The only time TRAA would respond into these areas would be if the local service is unavailable for some reason. East Central Fire & EMS does not honor TRAA’s LifeCare program. If you want coverage for their service, you will need to contact them about their ambulance program.
HOWEVER, if you work or shop in Fort Wayne, you may want to purchase TRAA’s LifeCare. TRAA’s LifeCare will cover you if you need ambulance service while working or shopping in Fort Wayne or in other areas of Allen county covered by TRAA.