Membership cover and non emergency transport

Scenario 1:

My mother is in a nursing home and needs to move to a higher level of care, is she covered?

Yes, provided that;

• the current facility can no longer provide the appropriate medical care that is required and;
• the transport is clinically necessary* and;
• there are no waiting periods in place.

Scenario 2:

My father is in a nursing home that is a long way away from me.  I would like to move him to a home that is closer to me.  Is he covered?

No.  Membership only covers transport when there is a clinical reason to move – such as moving to a higher level of care.

As per the Membership Scheme Business Rules, membership does not cover transport for social or convenience reasons.

Possibly.  If the transport is Clinically Necessary* as per the above definition.

Scenario 1:

I have an appointment at a hospital in the city, and I can’t drive. Can Membership pay for an ambulance to come and take me to my appointment?

It depends on individual circumstances.

There must be a genuine clinical need to use ambulance transport, where you need active medical monitoring during transport. If this is not the case, you will need to make alternative arrangements.

Not always.

In some cases the sending hospital will be responsible for payment as per the Department of Health & Human Services (DHHS) – Ambulance Payment Guidelines

• The transport must be Clinically Necessary*
• The choice of road or air service is a decision made by Ambulance Victoria based on the most appropriate transport for the patient at the time.

Scenario 1:

I am currently in a small regional hospital and need urgent surgery.  The doctor has told my family they can’t treat my condition and that I need to be moved to another hospital – am I covered?

Yes, provided that the sending hospital is not responsible as per the Department of Health & Human Services (DHHS) – Ambulance Payment Guidelines and;

The transport is clinically Necessary* and;

There are no waiting periods in place.

Scenario 2:

I have been admitted to a public hospital for ongoing treatment but I want to go to a private hospital nearer to my home and family – am I covered?

No.  You are not covered for transport where there is no clinical need to move – such as to be treated at a preferred hospital or doctor.  This would be considered social or convenience reasons.

Members are covered for the same benefits Australia wide as they would have received had they been in Victoria.   If you use transport interstate, you may receive an invoice from that state’s ambulance service which you would forward to the AV accounts department with your membership details listed. more info

• All the conditions relating to AV Services in Victoria will apply to the same services received interstate.
• Inter-state Member Benefits only apply for services provided by that State’s official State or Territory Ambulance Services.
• Before authorising a patient to travel interstate for a medical appointment, the referring health professional must contact AV and provide detailed evidence as to why the patient must attend an interstate health services.  AV may seek a second opinion.

Scenario 1: 

I was on a trail walking tour in a remote part of Tasmania and broke my leg.  I called the local search and rescue service who airlifted me to hospital – am I covered?

No.  Your membership would only cover you if you had called Triple zero (000) and that State’s emergency service initiated the response.

Your membership does not cover you for transport that is privately booked or not performed by that’s States official ambulance service.

Scenario 2:

I had an accident whilst on holiday in QLD and the hospital was unable to treat me.  They transported me to a larger public hospital – am I covered?

Yes, provided that the sending hospital is not responsible for payment as per the Department of Health & Human Services (DHHS) – Ambulance Payment Guidelines and;

• the current facility could not provide the appropriate medical care that was required and;
• the transport is clinically necessary* and;
• the transport is to the nearest most appropriate medical facility* and;
• there are no waiting periods in place.

Membership does not generally cover transport back to Victoria after treatment.

• In most cases the patient can be treated in the State where they are receiving medical treatment (the nearest most appropriate medical facility).
• Your Membership will only cover repatriation back to Victoria if the transport is assessed as Clinically Necessary* (e.g. the patient cannot be treated in the medical facility where they are and; the nearest most appropriate medical facility that can treat that condition is in Victoria).
• Repatriation must be approved by AV in advance.
• Membership benefits do not cover services where a patient requests to be moved back to Victoria for reasons that are not Clinically Necessary, for example you want to return to Victoria to be closer to home or family – this is considered social or convenience reasons.

Scenario 1: 

My mother needed brain surgery and the only doctor that would do it is in Sydney, so we flew up for treatment.  We want to bring her back to Victoria to recover at Cabrini Private.  Can membership pay for this?

No. Your mother would have to recover in Sydney at the nearest most appropriate facility that can treat her condition.  AV does not repatriate members so they can be treated at a preferred hospital or to be closer to home.

Scenario 2:

I am in hospital in Corowa NSW and need to go to the Hospital in Mornington VIC for specialist treatment?

Possibly.

Your AV membership will cover Clinically Necessary, transport to the nearest appropriate medical facility only (provided no waiting periods are in place).  If the nearest hospital that can treat that condition is in Victoria then your AV membership may cover the costs.

Whilst it is unlikely that the nearest facility that can treat you is interstate from your location, some specialist hospitals located in Victoria may be the most appropriate medical facility that can treat your condition.

Authorisation must be provided by a Health Professional who can make an informed decision about whether there is a genuine clinical need for a patient to be transported by ambulance instead of any other way and the transport must be booked via AV rather than privately booked via another provider.

Scenario 3: 

I have cancer and went on holiday to Queensland.  I’m now in hospital as I’ve gotten really sick, and want to come back to Monash in Melbourne as my oncologist says he can treat me. Can my Membership pay for this?

No. AV membership does not cover repatriation from interstate for social reasons, such as being treated at your preferred hospital or by your preferred doctor.

Scenario 4: 

I’m on holiday in NT, and broke my leg.  I’m in Darwin base hospital, but I want to come back to Melbourne. Can my AV Membership pay for the ambulance flight back to Victoria?

No.  You must recover in Darwin until you are able to travel by commercial means to return to Victoria.  If the hospital that you are in cannot treat your condition you may be transported to the nearest hospital that can treat your condition (provided the transport is Clinically Necessary).

AV Membership does not cover transport in the following situations;

• Non-Emergency Cases are not covered during the 14 day Qualifying Period
• Services used prior to 5pm (1700 hours) AEST the day after the Membership Fee is received by AV are not covered.
• Ambulance Services that are not deemed Clinically Necessary
• Transport from one private home to another
• Search and rescue – such as evacuation from remote locations when not booked via that State’s triple zero (000) ambulance service
• Relocation from one accommodation facility to another or, from hospital to home and return to hospital for weekend or holiday relief
• Transport performed by resources that are not contracted to AV or that are not performed by that’s States official ambulance service (where services are not the result of an Emergency Case or where pre-approval has not been provided by AV in advance)
• Transport that is the result of social or convenience reasons, for example;
  • The patient chooses to move to another hospital to be closer to their home and/or family (this includes returning back to Victoria from another State or Territory where they might have been receiving treatment),
  • the patient chooses to move to another hospital in order to be treated by a preferred physician

Booking Contact Details

• Bookings only (number to be used by medical staff/hospitals only) –  Triple Zero Victoria 1300 366 313.
• Please note that call takers do not provide information on billing/membership coverage and only take bookings from registered medical practitioners.