EMS Billing

[x635 4,066]

I should know the answer to this, but I never really got into the billing end of things.....

If you need an ambulance in an emergency, and you get billed for it, do you have to pay it??

I know many communities have "soft billing", but is that true for all agencies that bill for EMS? Are there agencies that make you pay, even if you can't afford?

My question pertains to agencies in NY and CT. My question originates here. A friend of mine had to use Greenwich EMS one time, and she recieved a bill for over $1000. Her insurance didn't cover it, and GEMS said she had to pay it, despite not being able to afford it at the time. They set up a payment plan with her to pay it off. So my question basically is, if you can't afford an ambulance but need one, and your insurance won't pay- you'll be forced to pay the bill?

[Oswegowind 17]

This one time at Empress.......

The Billing director thought she was a capo in the EMS mafia and the billing letter kind of go like this:

There is an easy way for us to collect this bill.

There is a hard way for us to collect this bill.

The easy way is you pay it.

The hard way is we go after you, and your credit.

Must have been great to get the bill right after having a heart attack and read this. Thanks to x307, I believe this has since been changed!

I think EMS billing should follow whatever rules there are for hospital billing. Volunteer agencies should accept whatever the person can afford to give in regards to the services rendered. Especially if the town already collects tax for EMS/VAC. Then residents should not be billed at all, but non-residents should be.

[KelliPVAC 32]

As far as EMS billing, it depends on the area. If the EMS agency is a tax district, they must have a signed agreement with their governing body.

Unfournately, there is no such thing as "soft billing". The pt will get approx 3 bills. The pt is billed for whatever the ins co. did not pay.

I think it sticks that there are people out there that are scared to call for an ambulance in the fear they won't be able to afford it.

[Guest Orpi442]

Yes, soft billing is really illegal, but it is practiced with the vols. We all know & understand Empress & the others. Here is a good one that Mason my recall. Several years ago my wife was treated & transported by Rural Metro in Florida. The insurance picked up half. I asked the company for the bill to be itemized because what was left was so high. You wouldn't believe what they charged. $25 for gloves $50 for 1000cc of NS, $35. for red bag & disposal.. this is just some of the list.

Well it was paid by packing all listed items in a box (provided by a provider thanks dm) , wrote on the bill PAID IN FULL, & mailed the box back to them. To this day I never heard anything from them. It was shocking that they a commercial company would charge for a box of gloves when the crew used 4 gloves total. Anyways as we all know they need to bill to be able to provide service.

[Guest WolfEMT]

Volunteer agencies should accept whatever the person can afford to give in regards to the services rendered. Especially if the town already collects tax for EMS/VAC. Then residents should not be billed at all, but non-residents should be.

In NJ, if an EMS Squad is on a volunteer basis, then they are barred from billing, as they would forfeit their 501©-3 (charitable organization) status. If the above is accurate, VACs in NY can still bill for services rendered despite being a volunteer organization?

As far as billing is concerned, then the ambulance should adhere to whatever rules there are governing emergency hospital care. It is, after all, an emergency room on wheels.

[helicopper 1,050]

A friend of mine had to use Greenwich EMS one time, and she recieved a bill for over $1000. Her insurance didn't cover it, and GEMS said she had to pay it, despite not being able to afford it at the time. They set up a payment plan with her to pay it off. So my question basically is, if you can't afford an ambulance but need one, and your insurance won't pay- you'll be forced to pay the bill?

I'd demand an explanation about what exactly cost $1000 and then argue with my insurance company to pay more of it to reduce my out of pocket expenses. As Orpi said, if they're charging for a whole box of gloves or ridiculous amounts for supplies those portions of the bill cna probably be challenged effectively.

I think EMS billing should follow whatever rules there are for hospital billing. Volunteer agencies should accept whatever the person can afford to give in regards to the services rendered. Especially if the town already collects tax for EMS/VAC. Then residents should not be billed at all, but non-residents should be.

Hey, Mr. 1000 posts! Billing non-residents but not residents would be a discriminatory practice and prohibited by HCFA/Medicare regulations and other rules the way it's been explained to me.

In NJ, if an EMS Squad is on a volunteer basis, then they are barred from billing, as they would forfeit their 501©-3 (charitable organization) status. If the above is accurate, VACs in NY can still bill for services rendered despite being a volunteer organization?

As far as billing is concerned, then the ambulance should adhere to whatever rules there are governing emergency hospital care. It is, after all, an emergency room on wheels.

I think most EMS agencies are bound by the same rules as hospitals, doctors offices, etc. Medicare and others set the rates and that's pretty much the end of that. It is up to the agency to determine how aggressively they're going to pursue collection though.

As for losing 501C3 status because of billing, I would check with a lawyer or accountant because I don't think that is necessarily the case. You can bill for services rendered and still be a charitable organization. The key point is where does the money go when it is received - if it goes back into the agency, you should be OK with the IRS.

[MerlinMedic 5]

Soft or Hard billing? A soft bill is what we call it when the agency does not go to collections for a bill after the 3 letters have been sent. This is leagal in NYS. Many vollunter agencies do this, as do some municipalities. Hard billing is when the unpaid part of the bill is sent to collections. I do not know what the commercial providers do in Dutches, Putnam & Ulster. I was very surprised to find that the Town of Colonie EMS does do hard billing AND is a tax district AND is municpal. They also bill for ALS if the call was dispatched as ALS, even if it goes BLS.

I am sure that what Colonie is doing is leagal.

What the other agencies need to do is be consistant: if you write off those who don't pay the co-pay after 3 bills for 1 person, you do it for all. If you send 1 bill to collections, you do it for all, other wise, aas was said before it is Medicare fraud.

Hope this helps.

[Guest]

I should know the answer to this, but I never really got into the billing end of things.....

If you need an ambulance in an emergency, and you get billed for it, do you have to pay it??

I know many communities have "soft billing", but is that true for all agencies that bill for EMS? Are there agencies that make you pay, even if you can't afford?

My question pertains to agencies in NY and CT. My question originates here. A friend of mine had to use Greenwich EMS one time, and she recieved a bill for over $1000. Her insurance didn't cover it, and GEMS said she had to pay it, despite not being able to afford it at the time. They set up a payment plan with her to pay it off. So my question basically is, if you can't afford an ambulance but need one, and your insurance won't pay- you'll be forced to pay the bill?

The answer depends on the provider. Just like other businesses, ambulance providers have to cover their costs. A $1,000 bill for service may not be extraordinary if you take into account that that call doesn't just include the cost of the fuel for the truck. It also includes overhead such as rent, capital expenses, insurance, salaries for the crew, dispatchers and office staff, vehicle & equipment replacement & maintainence costs, fuel, electricity, etc. Contrary to popular belief, it is hard to make a profit in EMS!

When you put it all together and then take into account that insurance companies NEVER pay the full amount of the bill (sometimes they will pay as little as $100 on a $1,000 bill), that money has to go a long way!

It seems that some posters on this forum will rant about how little they get paid to do their job but in another post would be insulted that ambulance services would charge for their service. Take pride in your profession, whether you collect a paycheck for doing it or not. Every other segment of healthcare charges for their services and expect payment for it. Why should we be any different?

For anyone who thinks they do not charge for their service, you are mistaken. You are receiving your funding from somewhere, whether it is through taxes, a town contract or through billing. While you may not be charging for your time as a volunteer, your agency is charging someone for everything else.

People pay insurance premiums for coverage. It would be silly not to bill the insurance company for a covered service. If you didn't charge them, the only one making out on the deal would be the insurance company, who is also in business to make a profit.

It seems I may have started to rant. To get back to the original question, if a patient cannot afford to pay a bill, an ambulance service should provide information on applying for Medicaid and also have a policy to provide for a payment plan and a certain amount of charity care. After all, in an emergency, it is not like the patient has an opportunity to shop around for a provider and we NEVER want them to refuse care because they would have to decide whether to eat or pay an ambulance bill.

Mike

[Guest]

i really don't see the big deal?? my vac pays for a tech and/or driver when we don't have a vollie to do so. we "soft bill" to replenish what we use for the paid guys...and i call that being responsible

1. for making sure the bus gets out the door. unlike some vollies i have no "vollie ego." i could care less who does the call (vollie or paid), as long as the rig gets out the door.

2. vac's are not like FD's, we don't get a butt load of money from the state and municipaities, we get less than $80K a year. replenishing the funds is only right.

...PEOPLE GET THE HINT, IT'S NOT ABOUT BEING A VOLUNTEER ANYMORE, IT'S ABOUT GETTING THE JOB DONE!! I DON'T CARE WHO DOES THE JOB, JUST MAKE SURE IT GETS DONE!

once you rejects let go of your egos, you'll finally realize that volunteerism is decreasing very fast and in my town, we will be going paid faster than you think. i don't like it...but its just the way it is...

how we operate in my vac, changes w/ the times, the way it should be. other surrounding agencies need to step up to the plate....of course i will mention no name....BUT...lets just say, 3 of the 4 EMS agencies already have stepped up to the plate...

[Guest]

When you put it all together and then take into account that insurance companies NEVER pay the full amount of the bill (sometimes they will pay as little as $100 on a $1,000 bill), that money has to go a long way!

this is exactly why we only make what we use, its just how it works out.