METROPOLITAN MEDICAL TRANSPORTATION IPA, LLC
NATIONAL MEDTRANS NETWORK, INC
I understand that Metropolitan Medical Transportation IPAA, LLC and National MedTrans Network Inc. (collectively “MMT), have established a network of Providers who have agreed to provide transportation services to covered persons under benefit plans offered by health insurers, health maintenance organizations, prepaid health services plans, self-insured employers and other payors in exchange for reimbursement at negotiated rates.
Current Payor Benefit Plans. I hereby acknowledge that I have authorized MMT, through the participation agreements I have executed with Metropolitan Medical Transportation IPA, LLC and National MedTrans Network, Inc. (collectively “the MMT Payor Agreements”), to bind me to participate in the Payor Benefit Plans identified below under the terms of such Payors’ participation agreements with MMT (the “MMT Payor Agreements”). I hereby certify that I have been given the opportunity to review the full terms of the MMT Payor Agreements, including the attached sample of fee schedules. I further acknowledge that my participation under the MMT Participation Agreements supersedes any other contractual arrangement I may have with respect to the provision of Covered Services to Covered Persons.
Centers Plan for Healthy Living
Future Payor Benefit Plans. In addition, I affirm my intent to participate with all additional Payor Benefit Plans that may be offered in the future, except for those I opt out of pursuant to the terms of the relevant MMT Participation Agreement.