Paramedic billing easing into effect
A fee forgiveness program is available for people such as the elderly or poor.
Paramedic billing easing into effect A fee forgiveness program is available for people such as the elderly or poor. Check out this story on thecalifornian.com: http://bit.ly/1RZT67F
Chelcey Adami, Salinas Published 4:45 p.m. PT Oct. 22, 2015 | Updated 5:27 p.m. PT Oct. 22, 2015
Salinas Fire paramedics respond to a medical emergency in this 2011 file photo.(Photo: The Salinas Californian)Buy Photo
As the Salinas Fire Department eases into enforcement of an ordinance approved to to recoup paramedic care costs, officials are reminding the public there are options for anyone who receives a bill for services.
The cost recovery program was approved unanimously by the City Council, with one member absent, last November and went into effect several months ago. It asks for reimbursement from insurance companies to help pay for the Fire Department to delivery emergency medical services.
Taking into account medical insurance and the Affordable Healthcare Act, the Salinas Fire Department did a study on what it costs to respond and care for someone on a medical call, said Salinas Fire Chief Ed Rodriguez.
The cost of having a fire captain, engineer and firefighter/paramedic, as well as costs of apparatus, infection control, emergency medical services oversight, dispatch fees, administrative rates and billing fees were all factored into the total cost of response at $341.74.
An increase in dispatch costs further bumped up the cost to a $350 flat fee that is now charged for the call, regardless of whether paramedics help treat a broken arm or cardiac arrest.
After a medical call, the biller, Wittman Enterprises LLC, sends the insurance company the bill directly, but people may receive a bill from the Salinas Fire Department if, for one reason or another, it wasn't able to collect the person's insurance information at the time of the service provided.
If that occurs, the Fire Department asks you to forward the bill to your insurance company or contact Wittman Enterprises at 1-800-906-6552.
While taxes do pay for the Fire Department to respond, the monies that the Fire Department is asking for have been set aside by most insurance companies to help pay for these services, according to Salinas Fire.
The Fire Department sees this as a way of supplementing taxpayer dollars with money that's been set aside for the service anyway and to ensure that critical EMS services are always available.
Based on the number of paramedic calls in 2013, officials estimate the first year will net nearly $750,000, and that money will go toward funding the Fire Department, including staffing, training and more.
Rodriguez notes that paramedic care is often more cost-effective than care received in a hospital.
The average ambulance ride is about $4,000, he explained, and the immediate care that paramedics provide can be critical and less costly than hospital care.
The fee program has always been available, and about 18 different agencies statewide use a similar fee program, including San Francisco and San Mateo, Rodriguez said. Changes with the Affordable Care Act were part of the prompt to make the change.
However, it appears that there have been a handful of communication glitches as the program has been implemented.
Despite past outreach to media and residents, some residents have sent inquiries or stopped by the Fire Department to question why they received a bill.
"The first year is always the most difficult with these programs, and we are committed to working together with all stakeholders, ensuring a fair and compassionate cost recovery program," said Salinas Fire EMS Officer Scott Houchin.
An elderly woman living in Salinas, who said she'd rather not be publicly identified, said she called 911 because she felt lightheaded and received a bill for $350. She said she called the number for billing inquiries but didn't get much response, and the experience has made her hesitant to call again.
Residents who use LifeLine! services are being advised that while they may receive an invoice for services, they are encouraged to contact Wittman Enterprises for special assistance provided for Lifeline clients to get the fee waived. Lifeline is a program run in conjunction with Salinas Valley Memorial Hospital that offers elderly or disabled residents a button to wear as a necklace or bracelet that they can push in the case of an emergency to get help dispatched.
The city of Salinas has been given a list of Salinas Lifeline! clients as a way to possibly prevent the clients from being billed, according to a letter sent to clients by SVMH.
While most commercial health insurance and almost all car insurance policies have coverage for this, Medicare and MediCal don't cover first responder fees at this time.
The Affordable Care Act has changed the reimbursement process for medical billing, and there's discussion in the state Legislature to possibly allow the first responder fee to become reimbursable in the future, said Houchin.
In the meantime, all Medicare and MediCal patients are offered a reduction of the first responder fee or they can have the fee waved when they meet financial hardship criteria, he further explained.
"We understand that many of the MediCal and Medicare patients meet the financial hardship criteria. They should never be afraid to call 911 in the event of an emergency for fear of receiving a first responder bill," Houchin wrote in an email. "By contacting the billing company and completing the required paperwork, there will be a reduction or a forgiveness of fees in every situation for Medicare and MediCal."
Since most of the fire department's calls are from Medicare and MediCal clients, the Salinas Fire Department plans to propose to council a way to substantially reduce the fees by half or more for those clients, Houchins said.
"We're listening to all the feedback we're getting from the community and putting it into perspective," he said.
No one is ever asked for information up front, and the biller has a lot of latitude to work with people, Rodriguez said.
"The goal here is not to ever put someone in the poorhouse," he said. "It's never to move someone into incredible hardship but for us to recoup costs and defray costs of calls that the Fire Department may respond to."
Contact Public Safety Reporter Chelcey Adami at 831-754-4261 or cadami@thecalifornian.com
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