The Calvert County Board of County Commissioners has accepted a Memorandum of Agreement (MOA) with many of the fire, rescue and Emergency Medical Services (EMS) departments of Calvert County to authorize and implement a centralized EMS ambulance transport cost recovery system. EMS cost recovery for emergency transport is a means of receiving financial reimbursement for the cost of providing medically necessary ambulance transportation.
Beginning Jan. 1, 2023, the collaboration between county government and local fire, rescue and EMS departments will allow the approved vendor to bill insurance companies for emergency transport and distribute the fees according to the MOA. Patients will not be held responsible for associated costs or underpayment by insurance companies. Please see below for a list of frequently asked questions.
What is Cost Recovery? The process of obtaining financial reimbursement for the cost of providing medically necessary ambulance transportation. Medicaid, Medicare, and most other private insurance policies (health, auto and homeowner) already allow for reimbursement for ambulance transportation services. Calvert County Government has implemented this program in cooperation with a majority of the volunteer fire and rescue emergency medical services (EMS) companies to seek reimbursement of funds that help supplement some of the operational expenses for providing fire-rescue-EMS while giving some relief to the county’s general fund and ultimately the taxpayer.
The collaboration between county government and fire-rescue-EMS departments will allow the approved vendor to bill insurance companies for emergency transport and distribute the fees according to the Memorandum of Agreement between Calvert County Government and many of the fire-rescue-EMS departments of Calvert County.
How does cost recovery work? The same emergency medical services will be provided to all who need it, regardless of insurance coverage or ability to pay.
Insurance companies will be billed first for emergency transport. Unpaid costs by the insurance company may be forwarded to the patient who received emergency services. Although patients may receive a bill, Calvert County residents will not be expected to cover any associated costs or underpayment by insurance companies and will not be penalized for nonpayment.
How will collected fees be used? Funds will be used to support fire-rescue-emergency medical service (EMS) service in Calvert County. Fees collected will be distributed to the companies providing service, according to the Memorandum of Agreement:
Company providing transport – 70%
Calvert County Government – 30% (5% to offset costs of agreement; 95% to be allocated for the EMS services)
What happens if my insurance doesn’t pay the bill? Generally, once insurance makes a partial payment, the rule of thumb is to send up to three requests for payment for any cost-sharing that was applied. Cost-sharing includes co-payment, co-insurance and deductible. Once the insurance carrier has paid their portion of the bill, Calvert County will not bill residents.
How is my private information protected? Patient information will be requested at the time of service or collected and merged with records from the hospital where the patient was taken. Transmitted information will only include the data/information obtained by the emergency medical technician, to include patient vitals, signs, symptoms, medical history (if provided by the patient and documented), etc.
A third-party billing agent is responsible for processing reimbursement under emergency medical services cost recovery efforts. Information will be kept confidential in accordance with applicable federal, state and local laws, ordinances, regulations and policies.
Who is the point of contact if I have a question about my bill? The third-party billing vendor from whom you may receive a statement will have contact information with whom you may discuss your statement. You may also discuss your statement and coverages with your insurance carrier.
If there are lifesaving efforts at my house made, will that be a separate fee from the ambulance transport? There are different prices for cost recovery based on the level of service. The ambulance fee is a base fee; emergency medical technician fees are additional.
Are you charging based on mileage? Yes, insurance companies will be billed per mile of ambulance transport.
Is AAA Transport Service involved in cost recovery? No, AAA Transport Service is not a signer on the Memorandum of Agreement. They may have a different cost recovery service in place as they are a private ambulance service and do not respond to emergency 911 calls in Calvert County.
Will you bill for helicopter transport emergency transport services? Cost recovery involves ambulance transportation only. Calvert County emergency medical services does not include helicopter transport. Emergency helicopter transport is typically provided by entities such as the Maryland State Police or other private entities.
What is the average cost of an ambulance ride and does it vary by insurance company? Costs do not vary by insurance company but are determined by mileage and emergency services provided.
My insurance requires a copay. Who’s covering the copay? County taxpayers are considered to have already paid their copay. Non-county residents will be expected to pay their copay.
Do I have to show insurance information before I’m transported? No, showing insurance is not a requirement before transport.
Will I be denied services if I can’t pay the bill? No person requiring ambulance transportation shall ever be denied services due to a lack of insurance or inability to pay.
Will my insurance pay the bill? Whether or not insurance will pay the bill depends on the company and the plan. When a bill is received, insurance companies may request supporting documentation. Once that is provided, the insurance company may pay at least a portion of the bill. While you may receive a bill for the remainder, you will not be held responsible for covering nonpayment or underpayment by insurance companies.
Will I have to pay for ambulance at the time of service? No, patients will not be required to pay before transport.
When can I expect the bill? Insurance companies can expect a bill within a minimum of five days of services rendered.
Will this increase my insurance rate? We are not aware of any situations where insurance premiums have been increased as a result of fee for service billing.
Is there a late fee or penalty for not paying the bill? No, there is no penalty for inability to pay.
What if I have Medicare or Medicaid? Medicare and Medicaid are both included in this program. They are billed directly at their approved rates.
What if I am uninsured and not receiving Medicaid or Medicare? You will be contacted by mail or phone by the billing vendor to verify your insurance status. When this is verified, the bill will be written off.
If I can’t pay the bill, is the household or guarantor required to pay? No, they are not required to pay.
Does cost recovery affect non-residents to the county? Yes, anyone Calvert County who requires emergency medical services while Calvert County transport will be included in the reimbursement process for cost recovery.
I’m a Calvert County resident. What if an ambulance from St. Mary’s County transports me? You or your insurance company may be billed by the jurisdiction providing the service.
How far do they cover ambulance services? For example, if my child must go to Children’s National Hospital, are we covered?Billing standards require transportation to the closest medical facility; however, there is no change in coverage based on distance.