Manheim Township Ambulance Association

May 2016To Whom It May Concern:This notice is in response to a complaint filed by a *** *** ***This is in response to a complaint on the billing for services rendered for a service in March of 2016.Our service submits a billing for services rendered to all patients regardless of
participation with the carrierWe only participate with traditional Medicare and traditional PA Medical Assistance programsWe submit a billing to all carriers on the patients behalfSome of the Insurances such as *** *** *** and *** *** *** will pay the patient direct to which we always notify the patient upon submittingOther carriers will pay us direct even though we do not participateAll carriers know upon submission as to participation status as assignments of benefits is not checked on those claims.This gentleman first called and spoke with our Executive DirectorHe explained his concerns and was told that we could not adjust the billingHe then had a complaint on the crew which he was then directed to the Director of Operations for this concernOur concern on this part of the complaint is why anyone would wait for three months to bring up this concern and not call immediately if there was such a strong feeling on their actionsIt was not until he found he was being charged with the full balance of the billing that this was such a major concernHe then asked to speak to the billing manager as he was not getting an answer he liked from the other personsOur fees are in relation to other services here in Lancaster CountyWe are not permitted by law to share pricing as this would then be considered price fixing which is strictly prohibited under federal statutes.We have a subscription program in the township to which we send out notices every year to all households in our community (and this gentleman resides)It is explained what is covered and what is notWe give certain discounts to our Subscribers as allowed by law and federal statutesDeductibles are not permitted to be written off which is notedWe give a certain reduction to co-payments to our subscribers which are in guidelines set up by the Office of the Inspector GeneralThere are limitations and guides for how much you can write off throughout the year and we are compliant and remain well below this levelWe tried to explain to him that had he been a subscriber, he might have been eligible for this reduction but since he was not he would not be given a reductionHe was also advised to contact his carrier and see if they will apply more to his deductible since he is being balance billed or even pay a portion if his deductible has been met as they often do when contacted by the insured, as most carriers do not listen to the provider but do listen to the patient with whom they have the agreement and policy coverageIt would not be fair to give all patients who do not like their bills to get a reduction when the other people in the community have sent a Subscription to us for these reasonsIt is well known that coverage issues have dropped in recent years since Medicare had decided to come out with a list of coverage qualificationsUpon so doing, all other private carriers followed Suit in an effort to save moneyWe have also tried communicating with people that what a hospital and physician get paid for are NOT what an ambulance gets paid for and they must meet a certain criteria for paymentHe then bragged to us that he makes a $150,a year and he can afford it, but he brought up a concern on how could some of his employees afford these bills and was advised we try to work with these people to make payments.He made comment on how we stated we could just take her since we were thereThe crews are always thinking in the best interest of the patientThe providers know nothing of the billing or processes associated thereinWe advised that all patients have the right to say yes or no and if they wish not they sign a form stating they are refusing transport and accept all risk for their healthIt was then that it was stated we cannot just take them or this would be kidnapping which is what it is called in PennsylvaniaALL persons must agree to go with the ambulance or We cannot take themThe only exception is if they are a danger to themselves or others and then a Command Physician from the hospital must make that orderThose are extraordinary circumstances and are very un-common in practice.The gentleman made statements which were rude and condescending as wellIt was viewed as threatening since he was not getting what he wantedIt was felt he thought if he threatened enough we would back downOur billing practices are legal and always above boardWe always try to explain to patients our costs concerned with operating in order for them to understand pricingUnfortunately ours is a service where people don't have choices when placing a call other than if they wish to be treated and transported and to which hospital they wish to be transported to, or if they wish to refuse to be transported at allIt is illegal to discuss finances during a call as this is considered placing undue stress on a patient during an emergency situation to decide between finances and their health issuesOn a routine transport service this is permissible discussion as there is no emergent need at that time.We thank you for your time and consideration in this matterWe are understanding of your duty to obtain all the facts and follow up with all concerns.Sincerely,Terri SExecutive Director