In September of 2017, the board of directors for the Sun Lakes fire district and the North County Fire & Medical District voted to end their current ambulance patient subsidy practices and implement an ambulance membership program.
The reason for this change boils down to simple math. The district’s emergency medical ambulance service is funded by the revenues received for transporting patients to the hospital. By state law, the districts cannot use tax revenues to support their ambulance operations. Therefore, if insurance payments do not cover the costs of providing the service, then something must change. Instead of reducing any of these critical and essential services, the district fire boards opted to end patient subsidies.
“The ambulance patient subsidy program is basically a billing practice where the districts did not charge patients for their insurance copayments and deductibles. This program was started many years ago in a very different healthcare and insurance reimbursement environment. The new environment as it exists now is negatively impacting our financial ability to maintain our essential life-saving ambulance service,” AFMA Deputy Chief Rob Helie said.
“In reality, district residents’ primary insurance has always been billed, but they never saw that part of it, and anything that was not paid by insurance was absorbed by the fire district. Over the years, costs have increased to maintain state-of-the-art ambulances and equipment, a highly-trained work force as well as other operational needs associated with providing the highest level of medical service with enough ambulances on the road to meet the requirements of our residents.”
Chief Helie continued that the districts were forced to do something to keep their ambulance services sustainable. “We hope our ambulance patients will realize that we are only asking for those that use the service to pay their co-pays or deductibles in much the same way as when they go to the hospital or visit their doctor’s office. This is the same billing method as used by all other private, municipal or fire district based ambulance services in the valley.”
The district fire boards also approved a new ambulance billing program during that same September 28 meeting. In an effort to potentially offset the copayment and deductible costs, the districts are asking the Arizona Department of Health Services (ADHS) to allow them to implement an Ambulance Membership Program (AMP). If approved, this membership or subscription program would be strictly voluntary with an annual fee designed to eliminate additional out-of-pocket costs (copayments, coinsurance and deductibles) for members should they have an emergency and need an ambulance. This proposed program is being modeled after other fire department and emergency medical service agencies in Arizona and nationally.
Once the districts submit the applications for the proposed changes, ADHS can take up to 450 days to approve the application, but the districts are expecting the changes are likely to occur in 2018. Until the approval, there will be no change. If the application is accepted, the fire districts will continue to educate their residents as ambulance-billing practices change and ambulance memberships become available for purchase.
Chief Helie stressed, “Nothing will change from current practices until approval is granted by the ADHS.” The Chief then broke how the ambulance membership program would work. “We are requesting that the ADHS approve a rate of $75.00 for an annual household membership. One membership for the household covers out-of-pocket expenses for any medically-necessary ambulance transport by district ambulances within our jurisdiction. It does not cover neighbors or temporary visitors, but will cover AMP members anywhere within district boundaries.” Helie cited one example; “If an AMP member would be involved in a vehicle accident, as long as the ambulance transport is generated within the boundaries of the districts and a district ambulance provides the transport, the AMP membership would cover the patient’s insurance co-pays and deductibles.”
As proposed, if you take part in the AMP membership, it would be a considerable savings. Chief Helie explained, “It’s important to understand your insurance policy and specifically the co-pays and deductibles. For example, if a resident has a Medicare supplement with a $250. co-pay and they have purchased the ambulance membership, their total cost would be $75, a savings of $175. If you were not a member, you would be responsible for payment of any billable deductibles and co-pays.”
Chief Helie strongly emphasized, “The Ambulance Membership Program is strictly voluntary. We want everyone to understand that this will not affect access to district emergency medical services, including ambulance transport, if they do not join. The AMP is a supplemental insurance policy to help with or offset the “out-of-pocket” costs for the ambulance patient.
The money from the ambulance membership program goes back into the operating budget to cover operational costs, including making sure the ambulance fleet is well maintained and stocked with supplies.
For further information or to answer any questions you may have regarding the AMP, call Deputy Chief Rob Helie at 623-544-5400 or email him at [email protected]