Revenue Cost Recovery Frequently Asked Questions
Cost Recovery is 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/or homeowners) allow for payment for this service. The process has been implemented successfully by more than 40 localities in Virginia to recover necessary funds to support the increasing costs of providing EMS services to a growing population.
Emergency medical calls account for a large percentage of the total number of emergency service calls in the County. As the need for emergency medical service continues to grow, the County, like many other localities, is seeking ways to fund these services without relying solely on real estate property taxes. EMS Cost Recovery permits localities to recover system costs from those individuals who benefit directly from EMS delivery, including non-County residents, with the vast majority of the costs collected from Medicare, Medicaid and insurance companies. The County estimates that the annual cost of Fire and Emergency Medical Services is approximately $12M per year.
The program will not change the way emergency service is provided. No one will ever be denied emergency service because of the EMS Cost Recovery Program. If the patient calls 911 but is not transported, there is no charge. County residents with insurance will not be billed for any balances due after applicable insurance payments have been collected. County residents without insurance will not be billed at all. Non-residents, in cases of hardship, may apply to the County for a hardship waiver once all applicable insurance payments have been collected.
As of September 1, 2014, all Albemarle County ambulances, the Scottsville Volunteer Rescue Squad, the Western Albemarle Rescue, and the Earlysville Volunteer Fire Company squad are billing for service.
How much money will be recovered?
Albemarle County estimates that about $1.6 million will be recovered annually. These funds will be used to support and strengthen the Countyís combination volunteer-career system.
More than 40 cities, counties, and towns in Virginia currently bill for emergency ambulance transport to recover expenses. Our surrounding localities Augusta, Greene, Louisa, Nelson, Orange, and Rockingham bill for service, as do Richmond, Chesterfield, Hanover, and Spotsylvania. Nearly 80% of Virginia residents live in localities that bill for EMS transport. Nationally, that percentage approaches 85%. Many other localities in Virginia are currently considering this type of Cost Recovery.
Albemarle County has contracted with a billing company to handle its EMS billing. Once the patient information is collected, a claim form will be forwarded to the patient's insurance provider, Medicare, or Medicaid.
Albemarle County charges between $550 - $750 per transport, depending on the level of EMS care required by the patient.
No. Fees are only if a patient is transported.
What if I donít have insurance and am unable to pay or have insurance but am unable to pay any balances due?
Albemarleís EMS Cost Recovery program includes compassionate billing provisions. If the patient is a County resident, he will not be responsible for any balance due once all applicable insurance payments have been collected. If the patient is not a County resident and cannot pay, he may request a hardship waiver form and will not have to pay. All patients will be treated and transported regardless of the ability to pay.
All patients will be treated and transported. This program will not change the ambulance service provided to anyone in Albemarle County, regardless of insurance coverage or any other factor. Albemarle County will not deny service to those with delinquent accounts. Billing does not occur until after service has taken place. Emergency responders who respond to a call will have no knowledge of who has paid and who has not paid.
Unfortunately, health insurance premiums continue to rise regardless of whether or not a community decides to bill for EMS transports. Such factors as prescription drug coverage and litigation have resulted in escalating health insurance premium costs. However, ambulance transport costs represent less than 1% of health care expenditures. Many other local governments in Virginia have implemented a Cost Recovery program, and they have reported no evidence that EMS billing increases health insurance premiums
New funding made available through Cost Recovery will be used to offset the rising costs associated with supporting the Countyís rescue squads and other EMS service providers, helping them to continue providing the best possible service to the Countyís citizens.
The County provides funding for many of the basic operating costs as well as capital funding for equipment and vehicles, training and volunteer incentives. Without Cost Recovery, this funding would be provided entirely by tax dollars.
Yes. The cost of providing EMS services continues to rise and our volunteer EMS agencies will still need the publicís support.
Most agencies and billing companies alike who have researched this issue have found that billing for services has little or no impact on annual fund drive and donation collections.