By John Anderson
A recent discussion on The Auburn Site focused on ambulance billing by the Auburn Fire Rescue Department, and I committed to an explanatory article. This story took a week longer than I expected due to the information gathering required.
One of the issues was the belief that the Auburn Ambulance should be an “in network” provider for insurance companies so patients could be billed at a negotiated lower rate. The department does do this with both Medicare and Medicaid as required by law, and those patients are never billed for the difference between what was charged for the service and what was received from these government entities. Fire Chief Stephen M. Coleman Jr. told Auburn Mass Daily, “There is no such thing as an in-network provider when it comes to emergency medical services.” Insurance companies also don’t typically deny coverage for emergency transportation either.
Insurance companies often do have in-network ambulance services for non-emergency trips, and they require a “medical necessity form” before a patient is transported. A physician or charge nurse typically fills out that form, but the Auburn Fire Rescue Department is not in the non-emergency business.
Auburn offers two levels of care, Basic and Advanced Life Support, and each is billed at an established rate following guidelines established by the Fire Chiefs’ Association of Massachusetts. Basic Life Support allows for oxygen therapy, first aid skills, and patient packaging and is billed at the lowest rate. Advanced Life Support can involve EKG interpretation, intra-venous therapy, endo-tracheal intubation, cardiac defibrillation, and the administration of over 30 pre-hospital medications. No matter how many advanced skills are used, the patient is billed at a fixed rate.
State law requires each community to have a Service Zone Plan for EMS so that citizens receive the quickest response possible. Auburn Fire Rescue is the sole provider for an emergency ambulance in Auburn although units from neighboring communities are often relied on under mutual aid agreements. Private ambulance companies can respond to medical facilities in town like Reliant, ReadyMED, and the Life Care Center as long as the emergency is not life threatening. AFRD routinely receives calls from private ambulances when the emergency is urgent or they don’t have a unit available to respond.
As stipulated by the Massachusetts Department of Public Health and the Office of Emergency Medical Services, private ambulance companies cannot respond to an emergency at a private residence.
Two years ago, Chief Coleman fielded a citizen complaint when a private ambulance took 30 minutes to arrive at a residence. They could not find the address and then got lost on the way to the hospital delaying arrival to the emergency room by nearly one hour. Coleman met with every private ambulance company in the area and advised of a complaint to the state if it ever happens again. Now, he also receives a monthly report from each company showing where in Auburn they’ve responded.
The case in the above paragraph started when the patient’s family called his doctor who, in turn, called a private ambulance. Chief Coleman advises people to call 911, and if no transportation is required, the ambulance will leave and no bill is sent. By calling a medical office first, the response to the patient is delayed, even if just by the time spent on the phone.
When paramedic level ambulances operated by AFRD were first discussed back in 2005, the plan was to do it without impacting Auburn taxpayers. Thus, 10 firefighter/paramedics are paid directly from ambulance receipts. Fees also cover all the equipment costs and pay for replacement vehicles. Prior to AFRD taking on the ambulance, service was provided by a contracted private company with at least one dedicated ambulance in town. When someone was transported, they received a bill from this service, so billing should not be a surprise to residents.
Coleman says that there is better operational control with a department-based service. “As the Fire Chief, I’ve never had to come into the station the day after a tragedy resulting from a poor EMS response.” Auburn’s service is well respected, and despite over 10,000 calls since Coleman took over as Chief, he has received fewer than 10 complaints.
With respect to private insurance, co-pays and deductibles continue to surprise subscribers. Insurance companies dissuade them from going to emergency rooms for non-emergent situations by instituting high co-pays. There are no co-pays for dialing 911. Coleman did say that sometimes the ambulance bill is less than the patient’s deductible, but that deductible is going to be paid to some health care provider. It may just depend who mails their bill faster.
A person who truly cannot pay their ambulance bill due to their financial situation needs to talk to the Chief. When proof of need is shown, the department has the ability to waive the balance.
Chief Coleman wrapped up the interview with this statement, “We have a commitment to the citizens of this community to provide an excellent level of service.” And, they do.