Clarks Summit Fire Company Ambulance Subscription

The Subscription covers: 

• Emergency Medical Service (EMS) ambulance treatment and transportation. 

• Anyone residing at your residence.

The Subscription Program Policy: 

Medicare/Medicare HMO

• Co-Insurance - (This refers to Traditional Medicare) Subscriber is not responsible for paying if not paid by insurance. 

• Co-pay - (This refers to Medicare HMO) Subscriber is not responsible to pay the Co-Pay amount. 

• Deductible – Subscriber is responsible to pay the deductible amount. 

• Not Medically Necessary - If deemed non-covered for any reason, i.e., not medically necessary, the subscriber can pay the Medicare allowable OR file an appeal to Medicare. If the appeal is not successful, or if the patient never files for an appeal, the subscriber is responsible for the Medicare allowable amount. 

Commercial

• Co-Insurance - Subscriber is not responsible to pay if not paid by insurance. 

• Co-pay - Subscriber is not responsible to pay the Co-Pay amount. 

• Deductible - Subscriber is responsible to pay the deductible amount. 

• Not Medically Necessary - If deemed non-covered for any reason, i.e., not medically necessary, the subscriber will get a 25% discount off the gross charges. 

No Insurance and Medical Assistance 

•  Individuals with no insurance or have Medical Assistance are prohibited from participating in this subscription program. In the event a subscriber ends up being on medical assistance, the subscription fee would be refunded back to the subscriber and the Medicaid Payment would be retained. Medical Assistance prohibits its beneficiaries from participating in ambulance subscription programs. 

General Provisions

• Subscribers acknowledge that Clarks Summit Fire Company Ambulance will bill available third-party insurance for services rendered and agree to remit to any insurance payments received directly by the subscriber, to the ambulance service. 

• The terms and conditions of the Clarks Summit Fire Company Ambulance subscription program are subject to change without notice. A copy of the complete Clarks Summit Fire Company Ambulance subscription program policies is available at 321 Bedford Street, Clarks Summit, PA 18411. 

• This subscription program is not a contract. 

• In some cases, another ambulance service may respond and transport subscribers in place of Clarks Summit Fire Company Ambulance.  There is no obligation for another ambulance service to honor this subscription agreement. 

• This subscription program does not cover the provision of non-emergency

ambulance services or ambulance services which have been or should

have been pre-scheduled.

• This subscription program only covers those emergency ambulance

transports which are medically necessary and reasonable.

• This subscription program does not cover situations where the patient

refuses to be transported for treatment or where the patient or a third party

calls 911 for reason that is not an emergency requiring ambulance

transportation to the closest appropriate facility.

• This subscription program is not soliciting or offering an insurance policy. 

• The Clarks Summit Fire Company Ambulance reserves the right to cancel or revoke any subscription. 

• Each subscription is subject to acceptance by the Clarks Summit Fire Company Ambulance. 

• Subscribers are not voting members of Clarks Summit Fire Company.

 For more information, contact us at 570-586-9656 Opt. 3 or via email at EMS@CSFire.net