Fire and rescue operations come at a tremendous cost to the county – $1.83 million in fiscal year 2015 (FY15) and possibly $2 million in FY16, said Emergency Services Coordinator Cheryl Wilkins. A cost recovery program could bring in between $600,000 and $700,000 per year, Wilkins said, though she stressed the uncertainty of the estimate. A loaded mile cost, or a charge per mile driven with a patient in the ambulance, could recoup another $350,000 to $400,000 yearly.
Many counties have implemented cost recovery programs, said Wilkins, including Albemarle, Louisa, Nelson, and Goochland. Since cost recovery programs can be structured in many different ways, a Fluvanna work group studied the issue prior to developing a recommended path forward.
The work group recommends a “compassionate billing” approach to cost recovery. In compassionate billing, insurance companies are billed for ambulance transport, and then everyone – insured and uninsured alike – receives a balance bill. Hardship waivers are available for those who can’t afford to pay, and collections take a “soft” approach. Patients typically receive three bills, but then unpaid amounts are forgiven.
The work group considered billing only insurance companies and transporting the uninsured for free, but this approach may not prove to be legal.
Another component of the work group’s recommendation is a resident tax benefit, in which Fluvanna residents’ real estate taxes go toward any co-pays or deductibles left over after insurance pays.
Wilkins suggested hiring a half-time staff member to oversee and implement the program. She hopes to have town hall meetings about cost recovery in early February before a public hearing on the program proposed for Feb. 18. Supervisors could vote to establish fees for ambulance service on April 1, and an optimistic start date for the program would be the beginning of FY16, or July 1.
Supervisor Bob Ullenbruch expressed concern that the company hired to do the county’s billing wouldn’t be as soft on residents as the county requested. “You don’t know how someone is going to treat someone on the phone,” he warned, adding that if the billing company makes a percentage on returns it has motivation to go after Fluvanna residents. He also raised a question about the hardship waiver. “Having to prove you have a hardship is a hardship in itself,” he said. “What do you have to come up with?”
“It’s basically your word,” Wilkins replied.
“I acknowledge that there are concerns you’ve raised that are legitimate concerns,” said County Administrator Steve Nichols.
Len Bozza, president of Lake Monticello Fire & Rescue Squad, told supervisors that EMS providers worry that cost recovery will cause people to think twice before calling 911 for an ambulance. He said providers wonder if people with chest pains will think, “Oh, they’re not that bad,” and postpone the call for financial reasons. He also noted, however, that people already delay calling 911 for fear of hospital bills.
Supervisor Tony O’Brien questioned the resident tax benefit, wondering how much additional money the county could bring in if it didn’t apply real estate taxes toward the ambulance bill. People should be willing to pay for ambulance services, he stated, like any other medical bill. “It’s rational and reasonable to charge for it,” he said, adding that there will be systems in place to help those who truly can’t afford the bill. “I’m concerned that that one little clause there could be worth hundreds of thousands of dollars,” he said.
O’Brien preferred allowing residents’ donations to rescue services count toward their bill. That would encourage donations, he reasoned. Nichols warned that the administration involved in such an approach would be prohibitive, but O’Brien thought a solution could be found.
Staff will return to the Board with three different versions of a cost recovery program: one with a resident tax benefit, one without, and one that bills insurance only.
