Understanding the Patient Billing Process

EMT's Billing and Payment Policy

About a week after receiving care from EMT, patients will receive a billing statement for services provided. The bill will include an itemization of the services provided and the fees charged. Payment of the account is required within 30 days of receipt of the bill.

Most private insurance such as Medicare and Medicaid will cover emergency and non-emergency ambulance transportation. As a courtesy to our patients, EMT will submit a claim to their insurance. If the patient has coverage, it is important to provide all of the coverage information to the paramedic or EMT at the time of service or to the Patient Business Services offices as soon as possible after receiving services.

If the patient does not have insurance coverage of any kind, the bill for EMT services will be due directly from the patient. Payment is due immediately upon receipt of the bill. EMT will accept a personal check, Visa or MasterCard. A patient may also make payment arrangements by phone by contacting EMT's Patient Business Services at 1-888-689-6446, or by email at: [email protected]

Answers to your patient billing questions

Why do we require your signature prior to non-critical treatment?

All patients are required to acknowledge consent to treatment and transportation, provide authorization to submit a bill on their behalf, assign their benefits to EMT allowing their insurance to pay us directly, and acknowledge receipt of EMT's HIPAA Privacy Policy. HIPAA is a set of federal guidelines which all healthcare providers must follow. HIPAA requires all medical providers to gather the signature acknowledging we provided you with a copy of your rights under the HIPAA prior to providing services unless an immediate threat to life is present. EMT will not be able to submit a claim to your medical insurance carrier without a signed authorization from the patient or guardian. Failure to provide a signed authorization will also require EMT to seek payment directly from the patient or guarantor.

How are privately provided emergency services different?

Taxpayers fund public services such as fire and police protection, whether they use those services or not. Private ambulance services, on the contrary, are generally only funded by user fees. Under a private ambulance service system, you only pay for those services when you use them. This is generally a more efficient system.

In several jurisdictions the local government has contracted with EMT to provide emergency paramedic and ambulance transportation service for their community. When you call 9-1-1 for a medical emergency in one of these communities, EMT will respond to your call for help.

Does my insurance cover non-emergency services?

EMT provides comprehensive non-emergency transportation services to patients who need to be safely transported from one location to another. Insurance plans may cover medically necessary non-emergency transports, but your insurance carrier will determine whether or not ambulance transportation is justified as "medically necessary" according to their own specific criteria. It is important to check with your insurance provider to understand and comply with all requirements for authorization and qualification for non-emergency transportation. In some cases calling your insurance provider with supporting information may help encourage them to pay the bill on your behalf.

What does Medicare cover?

In general, Medicare will cover medically necessary ambulance transportation to the nearest appropriate medical facility. Most emergency ambulance transportation will qualify for Medicare coverage if the transport is a result of a sudden onset of a medical condition with acute symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in placing the patient's health in serious jeopardy, impairment to bodily function, or serious dysfunction to any bodily organ or part. Medicare requires that ambulance transportation be medically necessary and reasonable. To be medically necessary, Medicare requires that the use of any other method of transportation could be hazardous to the patient's health, whether or not any other methods of transportation are available. To be reasonable, for example, Medicare requires the patient to be transported to the nearest appropriate facility for treatment.

Non-Emergency Ambulance Transportation:

Certain medically necessary non-emergency ambulance transports are covered by Medicare, but wheelchair services are not covered under the Medicare program. Some non-emergency ambulance transports may require a certification of medical necessity signed by your physician. Medicare will not pay for ambulance transportation to a hospital or facility that is not the nearest appropriate facility, or a transportation performed for the convenience of the patient, the family, or physician. In general, Medicare will only pay for non-emergency ambulance service if the patient is unable to get out of bed without assistance, unable to walk, unable to sit in a chair or wheelchair, and/or that transportation by any other means would pose a hazard to the patient's health.

For both emergency and non-emergency transportation service, Medicare will pay 80% of the allowable rate. The remaining 20% will be due from you. If you have secondary insurance coverage, EMT will submit a claim on your behalf as a courtesy, but you are responsible for assuring timely payment by your secondary insurance carrier.

What does Medicaid cover?

While Medicare is a Federal program for qualified citizens over the age of 65 and for certain other qualified disabled citizens, Medicaid is a State program intended to assist medically indigent citizens. Because the Medicaid program is administered by the state, the coverage of medical services, including ambulance transportation, varies from state to state. You should check with your Medicaid program to understand coverage for ambulance transportation. In general, the Medicaid program requires that all ambulance transportation meet certain medical necessity criteria.

What does my insurance cover?

Insurance coverage varies widely from policy to policy. It is important that you review your insurance coverage to be sure that your policy provides ambulance transportation coverage and understand the limitations and requirements of your coverage. You should be sure to obtain authorization prior to receiving services from EMT if required by your policy. Contact your insurance carrier if you have questions about your coverage. If your policy does not provide 100% coverage for ambulance transportation, you may be required to pay a deductible or co-payment as directed by your plan. Payment of all deductibles and co-payments are due immediately upon receipt of the bill.

As a courtesy to our patients, EMT will submit a claim to your insurance if you provide your coverage information to us at the time of service or to the Patient Business Services office immediately after receiving service. Please be aware that as the policy holder, you are responsible for assuring timely payment by your insurance carrier. If your insurance carrier fails to adjudicate and/or pay your claim within the legally specified time frame (typically 30 to 45 days from receipt of the claim), EMT will seek payment directly from you.

What if no coverage exists?

If you don't have any insurance coverage of any kind, the bill for your services will be due directly from you. If you have a membership with our service in place prior to calling for our services and your services were medically necessary, you will owe us nothing.

How does EMT set its fees and rates?

Ambulance provider fees typically include a base charge for the transport, a mileage fee, and charges for any procedures, supplies or medications used. Your bill will provide an itemization of each of these charges incurred in your treatment and transportation.

Ambulance provider rates are determined by many factors such as the cost of providing the service and other economic forces in the community. EMT's rates are competitive for your community and meet all applicable local, state, and federal limitations, regulations, and approval. EMT's rates also meet all guidelines supported by the American Ambulance Association.

What if I am unable to pay the bill I have received?

If you are unable to make payment on a bill for service from EMT, please contact us for affordable monthly payment arrangements. We are willing to work with you to ensure that you can afford our services. Call or email our billing department at 1-888-689-6446 or email [email protected] for more information

We also offer memberships which can eliminate out-of-pocket expenses for medically necessary use of our services. Membership prices range from $10-$25 per year for an entire family. Unfortunately, memberships can not be purchased for services already performed.

To have a membership mailed to your home, please contact our dispatch center at 800-739-7661 or email [email protected]