FAQs

What if my insurance company will not cover my ambulance transport bill?: In accordance with the Compassionate Billing Policy, the City's billing service will attempt to gain all information required to show the medical necessity of the transport. However, if the claim is ultimately rejected, the Department will consider the charge noncollectable for City residents. If this occurs with a non-city resident, it is the intent of the City to bill for those services to seek reimbursement. Again, residents and non-residents if qualified, may apply for the waiver.

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Revenue Recovery Program

1. What is revenue recovery and why did the City of Poquoson implement this program?: Revenue recovery is the process of obtaining financial reimbursement for the cost of providing medically necessary ambulance services. Medicaid, Medicare, and the majority of other private insurance policies (health, auto, and/or homeowners) allow for reimbursement for this service. As the need for additional emergency responders increases, local governments have sought ways to pay for these services without raising property taxes. Many other local governments in Virginia have found that billing Medicaid, Medicare and private insurance for ambulance transport service has resulted in a large amount of revenue being recovered to help defray the cost of the service. The availability of such revenues led the City of Poquoson to join the more than 40 cities, counties and towns in Virginia which currently have such a system.

Charges include:

Refusal - $375.00

BLS
- $450.00

ALS1 - $550.00

ALS2 - $775.00

Mileage - $12.00 per mile

Oxygen - $50.00

3. Who do I call if I have a question regarding billing or insurance coverage?: Our new billing company, EMS Management & Consultants, Inc. has customer service representatives to address your questions at 800-814-5339. If you are not satisfied with this response or wish to speak with someone locally, you can contact Poquoson Fire Administration at 757-868-3510 or email questions to Emily Bond.

4. What happens if I do not have insurance or cannot afford to pay for this service ?: City residents who do not have any insurance and qualify for compassionate billing can submit a waiver, and fees will be waived.

5. What if my insurance company will not cover my ambulance transport bill?: In accordance with the Compassionate Billing Policy, the City's billing service will attempt to gain all information required to show the medical necessity of the transport. However, if the claim is ultimately rejected, the Department will consider the charge noncollectable for City residents. If this occurs with a non-city resident, it is the intent of the City to bill for those services to seek reimbursement. Again, residents and non-residents if qualified, may apply for the waiver.

6. If a resident has reached an insurance limit for the year and additional services are required, will the citizen receive a bill for these additional services, or can the fee be waived?: Several billing vendors advised that this should not occur, as most if not all policies do not have a limit on emergency transports related to EMS service. If this does occur, pursuant to Poquoson's Compassionate Billing Policy, the additional fees would be waived.

7. Can the billing company be directed not to send uncollected debts to a collection agency?: Poquoson's billing company will not pursue payment recovery through a debt collection agency without the expressed authorization of the City Manager or his designee.

8. Has this issue been resolved so the City will waive out-of-pocket expenses related to revenue recovery if they meet the criteria?: There has been discussion among staff regarding an Office of Inspector General (OIG) opinion that surfaced last year. This opinion relates to the jurisdiction being able to use any taxes (real or personal property) to qualify as the co-pay for City residents. The City is utilizing the OIG opinion for its residents, so the out-of-pocket expense for the co-pay will be waived for City residents.

9. Some residents have expressed concern that some people will hesitate in calling for assistance from the EMS crews when they have an emergency.: Ability to pay will NEVER be considered when providing service. Under the Compassionate Billing Policy, no one will suffer financial hardship as a result of necessary emergency medical services. When residents need emergency assistance, they should call 911 without hesitation. Most localities contacted, stated that call volume actually increased in some areas.

10. Will I have to pay for services if the ambulance does not transport me?: If you or your family members are assessed/evaluated and not transported, a refusal fee of $375 applies. This fee is often covered by insurance and is also eligible for waiver under the Compassionate Billing Policy.

11. How does the City spend the funds that are generated by this program?: Funds recovered from insurance companies in this third-party billing program are intended to be put back into the City’s General Fund.

12. Have donations to the volunteer agencies decreased?: Some localities initially noticed a slight decrease in donations; however, within a couple of years the donations returned to pre-revenue recovery levels. Poquoson City Council has indicated that if the volunteer organizations have a reduction in donations, an appropriation would be considered to make up the deficit.

13. If I do not have health insurance, are there other options that could be utilized to collect any fees that might be charged?: Several billing companies have indicated that many automobile insurance policies and homeowners' insurance policies provide some form of coverage if the insured was injured and required transport by ambulance. Billing companies routinely bill health insurance first, then auto, and lastly any other form of insurance.

14. How does the billing process work?: The City of Poquoson contracts with a private company to handle the billing process. After patient care is provided, insurance information will be obtained routinely, often at the hospital. The City of Poquoson will waive co-payments and deductibles for City residents. Non-insured residents will receive an initial statement from the billing company, while insured residents will receive an explanation of benefits (EOB) from their insurance company. Non-insured residents may apply for the hardship waiver. Please refer to the Compassionate Billing Policy (PDF).

15. Will visitors and non-City residents be charged a co-payment?: Yes, only City residents will have their co-payments and deductibles waived.