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January 06, 2010
In response to questions about the how an independent COVAC would impact the town of Cornwall, COVAC Chief Jack Boyle submits this explanatory letter that was sent to the Cornwall town board in October of 2008.
To the members of the Town Board:
I am writing in response to a series of questions posed by a resident.
This resident refers to a bill that her friend received, apparently for Advanced Life Support services (ALS) in conjunction with her call to COVAC. While I do not have any information to answer specifically, I can compare what happened to this patient with what would happen were COVAC to convert to the billing system we have proposed.
Medicare only approves payment to the transporting agency for ambulance services. Presumably, in this case, COVAC was the transporting agency and called ALS because of the nature of the illness or injury. COVAC does not bill but ALS must be paid. If Advanced Life Support (ALS) was not the transporting agency but billed Medicare for an intercept and assist services, the claim would have been denied as non-covered, and the individual receiving the bill would be liable for those charges.
Most secondary insurances are Medicare supplements designed to pay the coinsurance and deductible amounts not paid by Medicare. If Medicare denies a service as non-covered, there is no liability on the part of the supplementary insurer to pay for these services. Therefore, it is likely that her friend received no reimbursement from either Medicare or her supplementary insurance carrier and was liable for the entire bill, probably several hundred dollars.
Under the proposed system, COVAC would be the transporting agency and would be able to bill Medicare (or another insurance carrier) for both its services and ALS services. The patient would be covered for 80% of reasonable and customary charges under Medicare. If the patient had supplemental coverage, she would be reimbursed for all or most of the 20% difference.
COVAC’s intention is to alleviate the burden on Medicare patients under these circumstances. There will be a contract with ALS (which is required by Medicare as part of credentialing). When COVAC transports and ALS intercepts and assists, COVAC will be able to bill an ALS transport service to Medicare. Under current allowable schedules Medicare will approve $412.66, they pay $330.13 and the remaining balance of $82.53 is billed to coinsurance. This coinsurance will normally be paid by any secondary or supplemental insurance. In the absence of additional coverage the $82.53 will be billed to the patient. ALS will be paid by COVAC under the terms of their contact, and the patient would not receive a bill for the ALS services.
If ALS is not present during the call, COVAC will bill for a BLS transport. The Medicare allowable for this service is currently $347.50 which will result in a payment of $278.00 and a coinsurance amount of $67.50 to be billed to the secondary insurance or patient.
Medicare allows $6.55 per mile and will pay 80% of the total mileage billed.
Both ALS and BLS may bill all other insurance companies, and usually both services will be reimbursed.
Questions 1 & 2 – Basic Charge and Mileage
1. Medicare rates are: ALS $412.66, BLS $347.50, Mileage $6.55/mile
2. Medicaid rates are : ALS $230.00, BLS $150.00, Mileage $3.00/mile
3. Commercial, No Fault and Workers comp rates are: ALS:$800, BLS $675.00 and Mileage $12.00/mile
Question # 3 Medical Plans that cover ambulance service:
To date, all insurances except Healthy NY and one or two specific Blue Cross Plans cover Ambulance transports.
Question #4 If the patient’s insurance does not cover the whole cost of service, will the patient be billed for the balance even though they are a resident?
Every insurance policy has unique terms and benefits. Most have a deductible and or coinsurance. Deductible and coinsurance amounts often dictate the cost of insurance and many consumers consciously choose to assume higher obligations for lower costs. It is the patients’ obligation to pay their portion whether they are treated by a doctor, receive services in a hospital or transported by an Ambulance. Patients will be billed for the deductable and coinsurance amounts dictated by the terms of their insurance coverage. COVAC, similar to most community based volunteer ambulance corps, is sensitive to the financial burdens faced by community residents. Every resident will be made aware of accommodations available based on ability to pay and financial hardship. All billing and collections efforts will be approved and authorized by COVAC and only those individuals with a proven ability to pay or those that have received insurance payments directly will be aggressively pursued. The bills faced by most residents under this system will be substantially less than bills they presently receive for ALS services.
Question #5 If Medicare and Medicaid deny the bill how will this be handled?
All Medicare and Medicaid denials are researched and subsequently resolved according to the terms of participating agreements between COVAC and those entities. No patient will be held responsible for any amount that should be approved under the terms of their coverage with either of these insurances. If incorrect information has been provided, patients will be contacted by phone, letter or statement to verify appropriate insurance coverage.
Question #6 Many secondary plans do not cover ambulance transport
Secondary insurances that are Medicare supplements normally cover coinsurances and/or deductibles for Medicare approved services. Other secondary insurances provide benefits as specified in their policies. Since medically necessary ambulance transport is an emergency service most insurances, whether primary or secondary, include coverage for ambulance services.
Question #7 Since the taxpayers have built the ambulance building and paid for the equipment , including ambulances, will the Town be reimbursed in any way for these obvious start up costs for a paid service & should residents be asked to contribute in any way for a profit service?
The members of COVAC, who are also town residents and taxpayers, will be reimbursing the Town of Cornwall for the vehicles. It is very important that both town residents and Town Board members understand that COVAC has secured approximately $229,000 in donations and grants, in the past 5 years, to help offset the costs of the purchase of the vehicles which we will be buying back.
Since 1955, COVAC has been a private not-for-profit corporation, organized under the laws of New York State that has contracted with the Town annually to provide ambulance services in the Town. COVAC has never been a Town department or any part of Town government. Under the proposed system, COVAC's status would not change.
Question #8 In addition to paid billing service will other people be employed by the corps?
Under the proposed plan, COVAC intends to contract with an experienced billing service. This service will not be employees of COVAC. Unlike a majority of other local EMS agencies, COVAC does not at this time have paid EMTS or Drivers. COVAC reserves the right to hire paid staff in the future if there is a volunteer shortage that would jeopardize the safety and well being of town residents. Over the last 3 years, COVAC has had 1 paid clerical assistant to help keep up with the daily paperwork that is required by law.
Question #9 Will a professional service be called in for any transports?
COVAC is a professional ambulance service with over 50 trained and dedicated staff members. If the patients condition warrants a paramedic service than an appropriate provider will be called in to assist. This ALS service will in turn bill COVAC and not the patient.
Question # 10 Will two ambulances continue to be called in for 911 calls?
There are certain protocols which must be followed per New York state regulations. If an ALS service is needed then there will be more then one ambulance. This occurs on less then 30% of the calls we respond to. Our intent is for the paramedics to respond in first response vehicles and not ambulances.
Question # 11 Should the uninsured be billed at all?
Some patients who present as uninsured have coverage which is obtained only after they receive a bill. Based on the situation there may be coverage available through No Fault, Workers Comp, or other means. Additionally, some individuals with financial resources are uninsured by choice effectively electing to be self insured. All patient billing will be authorized and approved by COVAC. No individual will be required to pay beyond their ability and all requests for financial hardship accommodations will be considered.
Question #12 What advantages in quality of service will result in this change?. How will tax payers feel about bearing all costs of starting up a for profit venture?
It is important for everyone to understand that COVAC is a not-for-profit corporation and that will not change. Town residents will not be bearing start-up costs for a new corporation. The town will receive a fair payment for ambulances and COVAC will continue to use the ambulance building as before. Additionally any funds from the Town would be paid back as billing revenue is received. Many residents currently fear calling for help because they frequently have to pay out of pocket more then $700. COVAC will not force any resident who does not have insurance or co-insurance to pay of pocket for ambulance services. Additionally your ambulance district tax will go down to $0.. With the insurance reimbursements COVAC will better be able to equip our personnel with safety equipment for our members and have on hand better state of the art equipment which we are currently lacking. In regards to quality of service, Jeffrey Haber Executive Director of NYS association of towns stated “relying on volunteers to raise funds, as volunteer firefighters often do, is antiquated thinking. Flipping burgers and chickens, selling raffle tickets and running bingo games, particularly in lieu of training, apparatus and equipment maintenance and other EMS related tasks, is just a bad idea.” Under the proposed system, our members will be able to spend more time training and maintaining our equipment as opposed to the countless hours of fundraising to provide the top notch care we provide on every call.
Again, I sincerely hope this helps to answer your questions and shed light on our plan to move in the direction that all other local EMS agencies have. Please feel free to contact me with any questions at the corps phone number; 534-9510.
Jack Boyle
Chief of Operations
Comments:
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Thank you for publishing this! It has become so confusing as of late; this is welcome information.
posted by Stephen Sywak on 01/06/10 at 11:06 PM
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Yes - thank you for the detailed explanation. Makes a little more sense now. And thank you to COVAC for their service to the community.
posted by Chuck Trella on 01/07/10 at 1:03 PM
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