The Board of Supervisors decided unanimously Wednesday night (July 15) to set fees for ambulance transport beginning in September.  Then in a split vote (Supervisor Bob Ullenbruch dissenting) they selected a billing model for collecting those fees, known as compassionate billing.  Supervisor Mike Sheridan was absent on vacation.

Rather than setting dollar-specific fees, supervisors adopted fees as a percentage of Medicare’s allowable rates.  Cheryl Elliott, emergency services coordinator, recommended the latter approach because it eliminates the need to reset fees each year.  Rather, as Medicare rates change, the county’s rate will change with them.  Fluvanna’s rates for ambulance transport are now set at 125 percent of Medicare’s allowable charge.

What that equates to in dollars is complicated, depending on the medical qualifications of the personnel required to answer the call and the miles driven to the hospital.  Throughout the meeting $500 was used as a loose example of a charge for service.

Supervisors, who have discussed cost recovery for several months now, passed the fees quickly, but had more debate when selecting a billing model.

Elliott described two models: insurance-only billing and compassionate billing.  Under an insurance-only billing model, insurance companies are billed for the cost of the ambulance transport.  But whatever balance is left over is written off by the county.  Patients don’t receive a bill because they are considered to have paid their share via their taxes.

Compassionate billing, on the other hand, bills the patient for the portion left unpaid by the insurance company.  Hardship waivers and payment plans are made available in the 30-day and 60-day notices sent out.  But unpaid bills don’t go to collections.

One problem with an insurance-only approach is that it requires an opinion from the Office of Inspector General written specifically for Fluvanna County.  Without that opinion Fluvanna can’t treat insurance companies and individuals differently when billing.  While County Administrator Steve Nichols said the county could possibly obtain an opinion within 30 to 90 days, County Attorney Fred Payne cautioned it might not be that easy.  What’s more, Payne said, such opinions often end up changing, which could leave the county in the lurch.

Another problem with insurance-only is that it may leave money on the table, said Elliott.  By refraining from billing patients for the amounts unpaid by insurance, the county could forego what could be a significant amount of money.

But Supervisor Bob Ullenbruch raised concerns with compassionate billing that led him to favor insurance-only.  Though Elliott said that patients unable to pay the balance of their bills would have access to hardship waivers, Ullenbruch took issue with forcing residents to prove their poverty.  “Proof of inability to pay, to me, is insulting and demeaning to older citizens and folks that are on lower income or no income,” he said.  “I will never vote to embarrass someone and take away their pride.”

Ullenbruch pointed out that EMS|MC, the company contracted by the county to handle the billing, would be the ones contacting Fluvanna residents, not “our friendly staff.”

“We have complete control over what we say,” Elliott responded, adding that the letters EMS|MC will send are drafted by the county.

“I will vote for insurance-only because the cost difference in recovery…is worth it for those [embarrassing] things not to happen to the members of this community,” Ullenbruch said.  “My compassion is for them.”

Kim Stanley, chief customer officer for EMS|MC, made the point that when patients receive letters from her company requesting their insurance information, they are more likely to respond when they know they will be billed for whatever insurance doesn’t cover.  If they know the balance will be forgiven, they may pitch the letters in the trash, thereby cutting off the county’s ability to receive even insurance money – let alone patient dollars – for the transport.

Supervisors passed the compassionate billing model in a 3-1 vote.

Though estimates are fuzzy till more information can be obtained, the cost recovery program may bring in between $754,787 and $791,723 per year.

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