Rescue billing


Cheryl Elliott, emergency services coordinator, hosted the meeting, answering questions and providing information on the newly-approved policy to charge for ambulance transport.  Also in attendance to answer questions was Lake Monticello Volunteer Rescue Squad (LMVRS) Chief Joe Orsolini.

The cost recovery program uses a compassionate billing model, which means that bills are first sent to patients’ insurance companies, if applicable.  Patients are then responsible for the balance of the bill.  There are hardship waivers for people in need, as well as a monthly-installment payment plan.  After 30-day and 60-day notices, unpaid balances will not be sent to collections.

“What if I ignore your bills?” asked resident Sandy Carlson.  In theory, she said, she could ignore the bills, knowing nothing would ultimately come of it.  But her hypothetical widow friend down the street wouldn’t know this, Carlson continued, and would pay the bill.  “It’s a real hardship for her,” Carlson said, “but I don’t pay.  What are you doing to do to me?”

“We won’t do anything to you,’ Elliott said, “but I’d hope that [the widow] would call us to see what we could do.”

“So you’d just write me off as a deadbeat?” Carlson asked.

“We would, but there might be some communication,” Elliott said.  If the county, via its billing company, is taking the time to send the notices it would be nice, she said, if the hypothetical Carlson would take the time to write back on one of the notices that she would not be able to pay.

“What if people rebel against this [en masse] and decide they’re not going to pay?” asked resident Gerry Burke.

“I’d have to talk to the sheriff about that one,” Elliott responded.

The money that comes in through the cost recovery program, estimated to be perhaps $725,000 per year once the program is established, must go to funding emergency medical services.

“Does that mean we won’t have fundraising drives anymore?” asked Carlson.

The woman in charge of LMVRS’s fundraising drive echoed her concern, saying she suspected donations would decrease.  Often when people receive ambulance transport, she said, they will make a donation afterward.  If they pay for service she suspected that sort of donation would dry up.

When counties implement cost recovery programs, Orsolini responded, data shows that donations dip for about two years, but then come back.  Noting that donations account for over half of his budget, he said, “I can’t stop you from not donating…but without donations, LMVRS would shutter its doors.”

Rather than using a compassionate billing model, some other counties use an insurance-only model, which bills insurance companies but forgives any balances.  When Carlson asked why Fluvanna wasn’t using an insurance-only model, Elliott replied that in order to be able to treat insurance companies differently from people when billing, the county would need an opinion from the Office of Inspector General (OIG).  But the opinion, she noted, is just that – an opinion, not law.  If an insurance company were to come back years later and protest all the billing done under the insurance-only policy, it could prove to be a nightmare for the county.

“It’s been rumored that it’s just a formality about getting the [OIG} letter,” said Orsolini.  “It’s not a formality…it’s not a rubber-stamp type deal.  It’s a pretty complicated procedure.”

When Carlson asked if the county was looking into asking for an OIG opinion, Orsolini responded that the counties that do insurance-only all started with compassionate billing because it provided them with the data they needed to support their request for an OIG opinion.  Elliott agreed, saying that the county needs a “basis” of data for requesting the opinion.  “All we have is, well, everyone else is doing that, we want to do that too,” she said.  “That’s not a good basis.”

When the head of the fundraising drive said she thought this program would result in fewer calls to 911, Orsolini said that other counties have seen no dip in call volume as a result of implementing cost recovery programs.

“We are one of the last to come on board with this,” said Elliott, stating that 90 percent of Virginia counties charge for ambulance transport.  “You don’t go to the doctor’s office and expect not to have to pay.”  And a doctor’s office, she noted, will send patients to collections if they don’t pay.  “We will not,” she said.

“This seems like a done deal,” said Burke when Elliott asked for more questions.  “In the end it doesn’t matter what questions we have.”

Acknowledging that the announcement of the program has caused some fears, Elliott assured the group that rescues services will not change.  “We’re looking at money that insurance companies already provide for, and up to this point we’ve left it on the table,” she said.

“We don’t base our treatment on people’s ability to pay,” said Orsolini.  “We give patients the treatment that’s required.”


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