Carmel Ambulance Corps to bill consumers

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Carmel Ambulance Corps to bill consumers  

By: Eric Gross  

Putnam County Courrier

3/24/05

CARMEL-It's no April's fool joke!

 

Starting on April 1, the Carmel Volunteer Ambulance Corps plans on billing consumers.

John Koster, president of the ambulance corps, announced the new billing practice Monday that he said was being implemented to assist senior citizens.

Koster explained if the Carmel Ambulance Corps transported a senior citizen in need of advanced life support services (ALS), the patient received a bill from the county's ALS provider, Alamo Ambulance Company. Under current provisions, that bill cannot be passed onto Medicare since the local corps is the transporting agency and the consumer was being billed directly by Alamo.

Under the new arrangement, the Carmel Corps will do the billing that can be passed along to Medicare for reimbursement.

The ambulance corps has been working closely with Carmel Supervisor Robert Pozzi and members of the Carmel Town Board in devising the legislation and fee schedule.

Pozzi explained the billing dilemma had caused problems across America. "Years ago, Congresswoman Sue Kelly sponsored legislation that exempted ambulances associated with fire departments from billing patients. Fire department ambulances were covered but independent ambulance corps such as the Carmel, Putnam Valley, Garrison and Philipstown Volunteer Ambulance Corps were not."

Pozzi said special legislation was needed for independent ambulance districts in order to have senior citizens reimbursed for advanced life support services as opposed to basic life support.

William Huestis, director of the Putnam Office for the Aging, called the new plan a win-win. "I have heard stories where our seniors needed ambulances on two occasions within a month and received bills of over $1,000. A number of seniors have told me they would not be calling 911 when emergencies arose."

Huestis commended the ambulance corps as well as the Carmel officials for working together to alleviate the senior citizen's concern. "Medicare was not reimbursing seniors for their ambulance expenses. Unfortunately, sometimes government creates these loopholes. We have come together in a positive fashion to resolve the issue. If an elderly person needs an ambulance, he or she must call 911. Your life will be saved and you no longer have to worry about the cost."

Pat Greenwood, administrative assistant to the Carmel Volunteer Ambulance Corps, explained under the new provision everyone will be billed either $335 for basic life support or $474 or $522 for advanced life support depending on the medications provided by the paramedic.

"We had hoped to bill only senior citizens but found that policy would have been discriminatory. As a result everyone will be billed," she said.

Putnam Commissioner of Emergency Services Robert McMahon commended Carmel officials for resolving the issue. "The billing is necessary so we don't shortchange our senior citizens who may be Medicare eligible for reimbursement," he said.

Robert Herde, past-president of the Carmel Volunteer Ambulance Corps, stressed that everyone should call an ambulance if needed. "Never be afraid that you can't afford it. Everyone will be transported regardless of the ability to pay," he said.

 

[Guest WolfEMT]

Koster explained if the Carmel Ambulance Corps transported a senior citizen in need of advanced life support services (ALS), the patient received a bill from the county's ALS provider, Alamo Ambulance Company. Under current provisions, that bill cannot be passed onto Medicare since the local corps is the transporting agency and the consumer was being billed directly by Alamo.

My squad operates in the exact same way. We (the BLS Volunteer Agency) do the transporting with ALS medics on board our trucks. We have many elderly patients with Medicare as we have three senior developments in our area of response. While my squad does not charge, the patient recieves a bill for ALS services, which is successfully passed on to Medicare. How come this works in NJ and doesn't work in Carmel if Medicare is a Federal program?

[Guest NYTruckie]

When Sloper was doing ALS for Putnam they were getting $800,000/year for the 4 fly cars. Did they also bill? For example the Yorktown ALS district and Westchester EMS (Northern Westchester) Have contracts with ALS districts and they don't bill patients. Some of the vac's do bill, but not for the als service.

[Guest WolfEMT]

How can a VAC still be considered a "volunteer" agency if they do third-party billing?

[Guest]

Operating costs, such as equipment, rigs, insurance, protective gear, etc.

Of this billing process, the actual members gain no money themselves, but it all goes towards the operation of the VAC.

[WAS967 97]

How can a VAC still be considered a "volunteer" agency if they do third-party billing?

Since when does billing have anything to do with Volunteer status?

[Guest WolfEMT]

Quote:  

How can a VAC still be considered a "volunteer" agency if they do third-party billing?  

Since when does billing have anything to do with Volunteer status?

Since I'm basing my question on that state laws (NJ) that govern my Squad and on a prior situation - that's since when. My Squad has toyed with the idea of doing third party billing and we were told by the State Department of EMS that we would lose our volunteer status if we did so. Things might be different in NY, which is why I posed the question.

[WAS967 97]

Yes, they can still be volunteer. PCVAC started billing several year ago when I was a member. We never lost our volunteer status. I don't know why NJ won't let you keep your volly status, but then again, a lot of things in NJ are, IMHO, retarded. (Oh, I'm sorry....for the overly sensitive, "intelligence impared.")

[Guest WolfEMT]

Well, the state of NJ has never had the reputation for being one of the smartest states in the country, but I do have to agree with them on this one. The theory is that if a VAC/Squad receives any monies other than donations, ie through billing, they cease becoming volunteer and they start becoming a paid service. For example, Monroe Twp EMS (Middlesex Cty.) was a volunteer Squad up until about 5 or 10 years ago; they had to drop the word "volunteer" from their name, according to state law, since they became what the law calls "a paid service" once they started billing their patients for BLS services.

It follows logically that if a VAC/EMS Squad receives payment for its services, even if the monies received from payment are earmarked for the purchase of supplies, rigs, insurance, etc, it is not a fully volunteer organization since its members charge for their services.

[WAS967 97]

The theory is that if a VAC/Squad receives any monies other than donations, ie through billing, they cease becoming volunteer and they start becoming a paid service.

The distinction between Volly and Paid in my mind has always been at the level of the people themselves. If the staff are not paid, they are volunteer. If they get paid, then they are paid. What the upper echilons of the corps/dept do is, at least in this area, irrelivant. Perfect example is PCRVAC. They still use the VAC in the name, but have very few volunteers to my knowledge. Most of thier staff is paid. And I do believe they bill.

Most VACs use a form of billing called soft billing. The process in itself is a tad illegal, but most authorities look the other way. What happens is the VAC will send a bill to the incurance companies, medicare, medicaid, etc. IF they do not get 100% reimbursed (does that EVER happen outside maybe MVA case?) they are REQUIRED by law to send a bill to the patient for the remainder. But they don't follow up on it and basically tell patients to throw out a bill if they get one.

[Guest NYTruckie]

The question I have is legally can Alamo bill the patient if they already are getting money from the county to provide ALS? I was under the impression that only the transporting agency can bill. (maybe thats bill the insurance co). Just wondering is anybody has any other info?

[mikeinet 37]

Syracuse, NY - Rural/Metro gets paid to be the City BLS/ALS provider... and you sure bet they charge the patient... steap too. BLS ride gets you $400 plus I believe $60/mile

[WAS967 97]

It might be a part of Alamo's contract that they bill for services rendered and then they collect from the County what they cannot recoup from revenue recovery. That is how the Tri-Village (OVAC) flycar system started out. They got 50k seed money from each of the three villages to buy the equipment and start paying the medics. OVAC then bills to recoup costs. Any money they don't recoup is/was reimbursed by the villages. Back in the first few years they were well on thier way to self sufficiency. You'd have to ask someone more in the know (Gumby-Damn-It) if they still collect any monies from the villages.

As for $60 a mile in Syracuse. Thats either a typo or highway robbery. My Full Time job bills $7/mile. 9x that is a little over the top.

[STAT213 332]

And, unless something has changed, R/M gets $$$ 00.00 from the city. Its a contractless arrangement that started back when it was Eastern Ambulance Service. They bill the patients, and that was it. Nada from the city.