We might call this the anatomy of an ambulance run -- or the continuing analysis of an ordinance. I'm not sure which. Either way, or anyway you want to refer to it, this is a continuation of the question of "how do we pay for rural ambulance service?"
In a previous article, I shared my experiences of the Pea Ridge ambulance service where both my wife and I were taken to the hospital under emergency circumstances. This is really a more detailed account of my own trip with the intent being to cover the costs of the service in additional detail which was not a factor at that time. In any emergency, cost is not a factor until after the emergency has been alleviated.
In May of 2009 when I suffered extreme chest pain, the Pea Ridge ambulance picked me up at our home and transferred me to Bentonville's advanced life support ambulance about half-way between Pea Ridge and Bentonville. The Bentonville crew began the procedures to cover a heart attack and delivered me to Northwest Medical Center (my choice) Emergency Room. The specific details of the care administered are not relevant to this article, but as I noted in an article in June 2009, the chest pain was not an indication of a heart attack. What is important to note is the fact that in an emergency, the adequate care and service must be available.
One of the most important questions -- how serious the condition really is -- can only be answered over time and that time is crucial in case of a life threatening emergency. I do not profess to understand the billing procedure for Bentonville's ambulance service that night. What I did learn after the fact is that only the service that delivers the patient to the Emergency Room submits a bill. In my case, the bill was submitted to Medicare for individual items of $400 (ambulance -- I assume this was the basic fee allowed by Medicare in 2009), $47.26, $25, $25 and $10.50 (all listed as ambulance also). One line item was $35 (noted only as X-Ray-IP) and the final item was $2.21 for medical. The total bill was $541.47, Medicare approved 76.74 percent or $415.53 and paid 80 percent of that ($332.43) with my supplemental insurance paying the remaining 20 percent ($83.10).
Those numbers are meaningless unless you think of the cost coming out of one's own pocket. The cost of a Medicare supplement package that pays the 20 percent is expensive and premiums continue to rise. Last year's premium raise was listed as "in anticipation of rising medical cost." I assume that related to the expectation that the Affordable Care Act was going to be a factor in future costs. A change in my supplemental insurance to Blue Cross-Blue Shield Advantage Plan (PFFS) put me in a plan that has no premium, but the out of pocket co-pay cost of an ambulance is $250 for the insured patient. There are far too many insurance plans with various methods of calculating payment for ambulance service runs to even attempt to discuss them here. The important thing is for voters who might be affected by this ordinance to become informed of their own situation and potential liability.
Everyone should read the ordinance in detail and be sure they understand how it might affect them. What is said in the ordinance leaves much to be determined by the ambulance service. The wording in the ordinance, Article 5 Section (f) states "In addition to the per household fees described above, a provider of services serving BCEMSD No. 2 shall also be entitled to charge for the provision of emergency medical services described in Article 3 above (including all costs of labor, materials, and overhead) on a per unit of service basis when such services are provided, and collect same to the extent such provider is not prohibited from making such charges in any agreement with the County to provide such services."
According to a recent letter published in The TIMES and written by the treasurer of NEBCO, they will not bill NEBCO emergency medical services district residents for ambulance service. The letter did not state whether or not they would submit a bill to an insurance company if the patient has insurance. The letter did state they would bill individuals for ambulance services if they were not residents of the NEBCO EMSD. I do not know if the cities invoice their residents for ambulance runs or if they even bill insurance carriers.
What all this shows, or reveals, is the complexity of providing service to rural county residents at a cost affordable to them and fair to the ambulance services.
Many ambulance runs are made in the course of a year and they frequently transport people who are uninsured and/or are unemployed and the agency probably receives no revenue from that service. It might be unfair to expect the municipalities to cover all of the unincorporated area without reimbursement, but the fact that rural patrons shop in municipalities and pay sales tax should help the Quorum Court members in their study of how to come up with the finances needed to reimburse the cities. Any member of the Quorum Court has access to the sales tax split with cities.
And there is no mention of Air Evac or other air ambulance services in any of the discussion of this ordinance so far. Is this ordinance about funding the cities or providing Emergency Ambulance Service to rural Benton County?
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Editor's note: Leo Lynch is an award-winning columnist. He is a native of Benton County has deep roots in northwest Arkansas. He is a retired industrial engineer and former Justice of the Peace. He can be contacted at [email protected].
Editorial on 12/25/2013