EMS Transport Billing in James City County
Billing for ambulance transport by the Emergency Medical Services (EMS) Division of the James City County Fire Department began on July 1, 2007. The Department is committed to providing the finest emergency medical services possible for our community residents and visitors.
Why does the County have a revenue recovery program?
Medicaid, Medicare and the majority of private insurance policies include the cost of ambulance transport. As the need for additional emergency responders increases, local governments have sought ways to pay for these services without raising property taxes. Many other local governments in Virginia have found that billing Medicaid, Medicare and private insurance for ambulance transport service has resulted in a large amount of revenue being recovered to help fund Fire/EMS services. The availability of such revenues led James City County to join the more than 40 cities, counties and towns in Virginia which currently have such a system.
How does this affect me?
If you have private insurance or are covered by Medicaid or Medicare, it will probably not affect you because you have already paid for the cost of ambulance transport through your policy or coverage.
What is Emergency Medical Services (EMS) Revenue Recovery? This is the process of obtaining financial reimbursement for the cost of providing medically necessary emergency ambulance transportation.
What if I don’t have insurance and can’t afford to pay? Patients who demonstrate financial hardship may be eligible for a hardship waiver, sliding scale deductibles, or a payment plan that may require moderate payments with no interest or penalties. All patients will be cared for and, if necessary, transported to a medical facility regardless of their ability to pay.
If I have a balance to be paid on my bill, will I be refused ambulance service?
James City County will not deny ambulance service to those with delinquent accounts or anyone else. This program will not change the ambulance service provided to anyone in James City County, regardless of insurance coverage or any other factor. Emergency responders will have no knowledge of who has paid and who has not paid a previous bill.
If EMS comes to my house but I don’t need transport, will I receive a bill? No. There is no plan to charge for a situation where the patient is not transported to a hospital.
Will my health insurance premiums increase as a result of this billing?
Unfortunately, health insurance premiums continue to rise regardless of whether or not a community decides to bill for EMS transports. Such factors as prescription-drug coverage, litigation, technology improvements in the medical field and depressed insurance company investment returns have resulted in escalating health insurance premium costs. However, ambulance transport costs represent less than 1% of health care expenditures. Many other local governments in Virginia have implemented a revenue recovery program for ambulance transport fees, and they have reported no evidence that EMS billing increases health insurance premiums.
What type of information will I have to give when the ambulance arrives?
Persons using the Emergency Medical Service are asked to provide any insurance information you have at the time of service, whenever possible. Attending to the patient’s medical needs will always be the first priority.
What if I am not able to provide the insurance information at that time?
If your insurance information is not available at the time of service, the billing company will attempt to obtain the information at the hospital. If the information cannot be obtained, you may receive a letter asking you to provide the information. You can contact the billing office to provide the information. When the billing office receives the information, your insurance will be billed. You will not receive any further correspondence or bills until the insurance company has made a determination on your claim.
How do you protect the privacy of my health information? James City County has a federally required Health Insurance Privacy Protection Act (HIPPA) Compliance Program in place to protect your health information.
What are the billing rates for this EMS service?
The charges will be $550 for Advanced Life Support (ALS-2; an example is care which involves surgical interventions); $450 for Advanced Life Support (ALS-1; an example is response to chest pains); and $350 for Basic Life Service (BLS; which is the basic level of care provided). A charge of $7 per mile, from the location of the incident to the hospital, will also be part of each bill. You will not be charged for the distance the ambulance must travel from the rescue squad station to get to you.
Why is there a mileage charge?
Medicare requires mileage be included in determining the total amount covered for ambulance transports, and Medicaid calculates the allowable rate to be reimbursed based on mileage. A very large portion of the revenue that James City County anticipates collecting from this program will come from Medicare and Medicaid. The County needs to be uniform in its billing procedures and therefore charges mileage on all bills.
How does the billing process work?
The process is similar to that which happens when a person receives services from a doctor or health care provider. A claim is sent to the patient’s insurance provider, which sends the patient an Explanation of Benefits statement showing the amount the insurance provider was billed and how much the provider paid toward the claim. The statement will show what balance, if any, is owed by the patient for co-payments or deductibles.
What if I am unable to pay?
James City County’s EMS revenue recovery policy includes a provision for those with a financial hardship. If you can demonstrate financial hardship in accordance with the County’s policy, a substantial reduction is available. The bill can be paid in installments on a payment plan. If at any time during the billing process you claim a financial hardship that prevents full payment of the bill, you will be sent a Financial Hardship Certification Form. You must complete this form, attach the required documentation and return it to our billing office for processing.
What other localities in this area have EMS billing programs?
More than 40 cities, counties and towns in Virginia currently bill for emergency ambulance transport to recover revenue. Nearby billing localities include Richmond, Chesterfield, Petersburg, Colonial Heights and Hopewell. Nearly 80% of Virginia residents live in localities that bill for EMS transport. Nationally, that percentage approaches 85%. Many other localities in Virginia are also considering this type of revenue recovery.
When will this program start?
The Board of Supervisors approved the EMS revenue recovery ordinance in May 2007 for implementation on July 1, 2007.
The James City County Fire Department has chosen Diversified Ambulance Billing (DAB), Inc. in Virginia Beach, to provide prompt and accurate billing and filing of insurance claims for citizens who use the James City County Fire Department ambulance service. Diversified Ambulance Billing, Inc. utilizes the most up-to-date computer system for patient billing and is available to assist citizens with a broad range of ambulance billing issues. Our goal is to provide excellent customer service by working closely with patients, insurance companies, hospitals, and doctors during the billing process. If you have any questions or would like to schedule a community presentation, please contact us at (757) 220-0626.
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