Nichols Hills residents now have the opportunity to participate in the City of Nichols Hills’s TotalCare Ambulance Program. On October 1, 2009 our new Medical Service Program will be implemented and if you receive a utility bill from Nichols Hills you are enrolled. Residents who participate in TotalCare will have the peace of mind of knowing they will not have to pay out-of-pocket expenses for EMSA emergency ambulance rides given to permanent residents living in their home.
You may choose to opt out during the month of September but you need to be aware that an emergency ambulance transport starts at $1100 and you will be responsible for that total bill.
Following are a few facts to consider:
Cost is $2.50 per month, which will be billed on your water and trash utility bill. The first billing cycle begins in October 2009, which is the first day coverage begins for participants. Coverage for all participants begins October 1, 2009. If you choose to join EMSA TotalCare directly through EMSA the cost is $45 or $3.75 per month.
Apartment/Condominium owners are required to notify tenants if they choose to opt out of the TotalCare program. If your apartment/condo has chosen not to participate, you can call (405) 396-2888 and sign up.
You can opt out during the month of September by calling Utilities Customer Service at (405) 843-6637. By opting out you may be responsible for out of pocket expenses associated with treatment, should you require EMSA ambulance care.
What is not covered:
TotalCare does not cover non-emergency transports to and from doctors’ offices, dentists’ offices, physical therapy centers, pharmacies and other facilities. A non-emergency transport is an ambulance transfer that does not end at a hospital emergency room. Non-emergency transports are fully covered only if insurance or other third-party coverage pays a portion of the claim, and if a physician certification statement (establishing medical need for the ambulance transport) is provided. When no insurance or third-party coverage is available, TotalCare members pay a reduced fee (40 percent off the standard non-emergency rate) for medically necessary non-emergency transports.
EMSA will collect payment from participating resident’s insurance, Medicaid or Medicare. To receive TotalCare benefits, you must provide EMSA with your insurance/third-party payer information and furnish any information requested by your insurance company after a transport. Out of pocket expense will be covered by your TotalCare membership.
Frequently Asked Questions:
Q: If I participate, who is covered?
A: All permanent residents of your household, regardless of their age or whether they are a blood relative of the utility account holder. The person just has to reside in your household. Someone simply in town visiting is not covered. A good test is whether the person receives bills and mail at your address.
Q: I have insurance and/or Medicare. Why should I participate? (Isn’t it like I’m paying for the same thing twice?)
A: If insurance/Medicare always paid 100 percent of ambulance claims, you’d be correct. But the reality is this: insurance and Medicare deny about 30 percent of all ambulance claims. If this happened to you and you weren’t participating, then you would be personally responsible for paying EMSA’s full billed charge of $1,100 plus $9 per mile. Even when insurance/Medicare approve claims, many people still have a financial burden – a $50 to $250 deductible, a 20% co-payment with Medicare, or the difference between the billed charge and how much insurance will cover. If you participate in the program, you have no out-of-pocket costs for EMSA emergency ambulance transports. Whatever insurance/Medicare pays is counted as payment in full.
Q: I have Medicaid. Why should I participate?
A: Medicaid patients have no out-of-pocket costs for emergency ambulance service when Medicaid approves the claim. However, when Medicaid denies claims, the patient becomes personally responsible for paying EMSA’s full billed charge. By participating in this program, you’d have no out-of-pocket costs for EMSA emergency transports – even when Medicaid denies the claim.
Q: What constitutes an emergency transport?
A: An emergency transport occurs any time EMSA transports you to a hospital emergency room for urgent, unscheduled treatment of an unforeseen medical condition.
Q: What constitutes a non-emergency transport?
A: A non-emergency transport is a medical transfer that does not have a hospital emergency room as the final destination. For example, EMSA often transports individuals to nursing homes just after hospital discharge.
Q: Do participating customers receive benefits for non-emergency transports, too?
A: EMSA non-emergency transports are fully covered only if your insurance or other third-party coverage provides benefits for the service. That is, EMSA will accept as payment-in-full whatever your insurer pays on the transport and you won’t be subject to out-of-pocket costs. If you don’t have insurance or your insurance won’t pay for the non-emergency transport, you’ll be charged a reduced fee, which is 40% off EMSA’s standard non-emergency rate. A completed physician certification statement must be provided for a non-emergency transport to be covered. As an example, if you take an EMSA ambulance to the doctor’s office for a flu shot it will not be covered by TotalCare.
Q: Are there any excluded services?
A: Yes. The TotalCare program does not provide benefits for non-emergency transports without a physician certification statement. Also, repetitive transports for services such as dialysis, radiation therapy and chemotherapy are not included. TotalCare does not cover non-emergency transports to and from doctors’ offices, dentists’ offices, physical therapy centers and other facilities. Transports outside of EMSA’s service area are also not included. It’s a good idea to call EMSA at 396-2888 to discuss eligibility before requesting non-emergency service.
Q: If I opt out but later change my mind, can I resume participation?
A: Customers may change their election only during the annual September election period.
Q: If I opt out next September will I have to opt out every September?
A: No. Once you have made your choice to stay in the program or opt out, that decision will carry forward each year unless you contact the Utilities Department in September to change your status.
Q: I pay the TotalCare fee at my home, but my husband lives in a nursing home. Does he need a separate membership?
A: No. A participating utilities customer does not need to purchase a separate membership for a spouse in a nursing home.
Q: I pay for utilities at my two rent homes, in addition to my residence. Are my renters covered if I only pay the TotalCare fee on my home?
A: No. EMSA does not afford benefits to utility account holders, but rather to individuals living at participating addresses. Verification is made based by comparing the home address of the patient to a database of participating addresses.
Q: I live at ABC Apartments. I want to opt out.
A: Only the utilities account holder has the ability to opt out of the program. In most apartment complexes, water, trash pickup and other municipal utilities are paid by the property owner – meaning the property owner is the customer, not the individual tenant, and thus the property owner makes the decision on the EMS utility assessment on behalf of all his tenants.
Q: I have an active EMSA TotalCare membership. What does this mean for me?
A: EMSA has extended its 2008-2009 membership coverage period at no cost to members; your membership now expires on September 30, 2009. You can begin receiving TotalCare benefits through your utility bill on October 1 at an even more affordable cost.
Q: Will EMSA still have TotalCare?
A: Yes, for people living in nursing homes and in apartment complexes that opt not to participate, and for those living outside of city limits.
Q: I own/operate a nursing home/assisted living facility. What does this mean for us?
A: Nursing homes and assisted living facilities are classified as commercial customers. This service is available only to residential utility customers. But, residents of your facility can purchase an individual membership by contacting EMSA directly. There are no group or facility-wide memberships for commercial customers.
Q: I work in Norman (or other community EMSA does not serve), but EMSA doesn’t respond out there. What happens if I need an ambulance then?
A: EMSA is Oklahoma’s largest ambulance service, providing care in 16 communities (Oklahoma City, Edmond, Bethany, Mustang, Piedmont, The Village, Yukon, Warr Acres, Lake Aluma, Arcadia and Valley Brook, plus Tulsa, Bixby, Sand Springs and Jenks). Your program benefits will apply to transports within EMSA’s service area. If you need an ambulance while at work – or if you’re on vacation in another state, for that matter – a different ambulance provider will respond and you may be responsible for paying out-of-pocket charges.
Q: What about people who don’t have insurance?
A: If they participate, they have no out-of-pocket costs for EMSA emergency service. The amount they’ve paid through their utilities bill is considered payment in full.
Q: What if I need an ambulance while on business in Tulsa?
A: EMSA will respond, and your transport to a Tulsa hospital emergency room would be covered. However, an ambulance transport back to Nichols Hills from Tulsa would NOT be covered – as it would result in the ambulance leaving the service area during the transport.
Q: Why is this necessary?
A: The City of Nichols Hills currently funds ambulance service through our general fund, which is the same way we pay for street maintenance, many public safety programs and other expenses. Funding ambulance service through a special fee frees up general fund tax dollars for other community needs. And, in return, citizens will receive TotalCare benefits at a reduced rate.
Q: Where can I read the ordinance?
A copy of the ordinance will be available at City hall and will be placed on our Web site.
Click on the links below for aditional information: