City of Upper Arlington, Ohio

Emergency Medical Service FAQs

Does charging for EMS transports compromise patient care in any way?

No. All calls for help are answered in the same manner, regardless of insurance coverage or ability to pay.

What process takes place when a person calls 9-1-1?

All calls to 9-1-1 in Upper Arlington go to the Communications Center, located at the Municipal Services Center. Dispatchers immediately send the closest available unit that has the required equipment and personnel. This may be a medic unit, fire truck, or a combination of the two. Typically these are Upper Arlington units however, if all Upper Arlington units are busy with other emergencies, units from other communities in Franklin County are called upon to respond, thanks to mutual aid agreements that assure quick emergency service.

Are these mutual aid agreements compromised if communities have different or no EMS billing practices?

No. Mutual aid is recognized as an important mechanism for assuring comprehensive and responsive fire and medical emergency assistance to citizens of all Franklin County communities. Community leaders and fire chiefs of these communities have agreed that mutual aid will not be affected in any way.

What happens after firefighters arrive at an emergency location?

Appropriate treatment is rendered according to the injury or illness. Transportation to a medical facility is sometimes but not always required. If the patient's condition warrants it, the medic unit provides this service.

What happens differently with services that bill for EMS transports?

If the patient is in a condition to do so, he/she is asked for medical insurance information and a signature, as typically happens when being admitted to a hospital. If this practice might interfere with patient care, it is delayed or a relative is asked to provide the appropriate information. EMS reporting software currently used by Upper Arlington already collects most of the required information, and can be expanded to capture insurance information.

What can Upper Arlington residents expect?
  • Upper Arlington residents will not be billed for a transport or for any outstanding balance on a claim, even if they do not have insurance.
  • Residents may receive a letter requesting or verifying insurance information if it had not been obtained in full at the time of the EMS transport.
  • Some private insurance companies may submit payment to the patient when it should be sent to the City. If this occurs and the patient has not forwarded the check to the City, he/she will receive a letter from the City requesting reimbursement.
  • In some cases whereby an EMS transport is provided by another jurisdiction through mutual aid, the policy of that responding agency will apply, therefore Upper Arlington residents may receive a bill for any balance due on the claim.
 
What can non-residents expect?
  • Transport claims will be submitted to Medicaid/Medicare/private insurance as before.
  • Non-residents will receive up to three bills for any balance not paid by Medicare/Medicaid/private insurance, or the entire amount if they do not have insurance.

What happens if I do not have insurance?

Responding to a call for help remains the top priority, regardless of an individual's medical insurance situation and ability to pay. Upper Arlington residents will not receive a bill for the transport or any outstanding balance, even if they do not have insurance. While non-residents will receive a bill for any outstanding balance not covered by insurance or the full amount due, the City will work with low-income individuals who do not have insurance as such cases arise.

Do health insurance policies cover EMS transportation?
 
Yes, both private and government health insurance plans include provisions for EMS transportation.

Do people have to pay for service the day it is rendered?
 
No. Once gathered, patient information would be forwarded to a third party billing agency contracted by the City and specializing in EMS billing. The patient's insurance company or Medicare would be billed for the run. Recent changes in rules set by the Department of Health and Human Services enables government entities to only invoice the patient's insurance company or Medicare, and does not require them to bill those who cannot pay or are indigent. They may also waive the coinsurance fee for their residents rather than adopt a "hard billing" policy that would result in invoicing the patient for the balance and taking a proactive collection stance.

Does EMS billing cause a significant increase in health insurance fees?

Health care costs will rise regardless of whether a community bills for EMS transports. The primary factors influencing such increases are prescription drug coverage, medical litigation, technology in medicine, and depressed investment company returns. Most private insurance and Medicare policies already have provisions in place for treatment and transport by an emergency medical provider. Billing for EMS transports allows the City to recoup some of its operating costs by taking advantage of existing insurance monies.

What annual revenue does the City realize through EMS billing?
 
The Fire Division averages 2,000 EMS transports per year (residents and non-residents). Based on these numbers and the rate-of-return seen by municipalities with similar demographics that already have EMS billing, the City conservatively anticipates an annual return of $400,000.

What are the resulting funds raised through EMS Transport Billing used for?
 
The funds raised are set aside to support fire and emergency medical services provided by the Upper Arlington Fire Division. This includes the support of facilities maintenance and upgrades, and the purchase of fire and EMS equipment and vehicles when needed.