When we talk to community members, they’re often shocked to find that EMS in Pennsylvania does not get nearly the level of support as our peers in the fire or police departments. EMS must rely on billing insurers or Medicare/Medicaid, resulting in frustrating payment delays, regulatory requirements, and billing policies that have contributed to the closure of ambulance services in the commonwealth at an alarming rate. As your community EMS agency, we’re asking for your support this year to keep high-quality, nationally accredited care right here in Carlisle.
Because many insurers have adopted high-deductible plans, we’ve had to change our 2022 membership program to ensure it continues to meet regulatory requirements. Starting in 2022, a member will receive a 50% discount on any medically necessary patient service or patient refusal. A detailed explanation of changes is found below.
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Ambulance memberships are major fundraisers for EMS agencies and have been around for decades. The two most important regulations that a membership must comply with are below.
- Memberships cannot replace health insurance – Your membership always worked with Medicare or Private Insurance to write off remaining balances. We were not able to write off care to those without insurance or with Medicaid plans.
- Membership programs must be actuarially sound – An Office of the Inspector General’s Rule in 2003 that looked to make sure that what is collected by the EMS agency reasonably matches what would be paid in copayments/deductibles
It was because of this second provision that our current membership was forced to change starting the 2022 membership year.
When ambulance memberships became popular fundraisers, the average deductible was around $500. Now, many people have deductible plans in the $5,000 – $10,000 range. We’ve also seen insurances begin to pay only half their customary amount, delay paying a second installment to an ambulance service, and attempt to have the remaining amount written off to membership- dramatically impacting our program’s soundness. Ambulance memberships like our own that previously had all out-of-pocket costs included in their provisions (which included deductibles) are seeing steady rises in the amount written off to membership, forecast to soon exceed the amounts we collect from this fund drive. While we have advocated for the past decade for our state legislature to fix the broken EMS payment system in our commonwealth, but it has not been an issue that our politicians have prioritized to pass.
As a result, we were faced with one of three choices- either end the membership program completely, substantially raise the cost of a membership (doubling it,) or reducing the write-off amount. We still see the value in this as our major fundraiser for the year, so we did not want to end it. We made the choice to keep it affordable but to limit out-of-pocket costs for members to 50% versus the previous full-write-off amount. In addition to helping ensure our service can respond to emergencies before they happen in our community, your ambulance fund drive contribution will allow a 50% write off for all medically necessary or patient refusal charges you may have been responsible for out of pocket.
We’re also limiting the memberships we honor to a geographic region of our first/second due emergency calls or those we have an agreement with. While this won’t affect those receiving this letter, it is a change from how we previously honored memberships nationwide.
We want to reiterate how this is our major fundraiser for the year and is our major source of preparedness income. Your membership funds in the past have been used to equip the PPE and decontamination solutions necessary to have ongoing responses to COVID-19 patients, to replace aging and mechanically worn ambulances, and to train the next generation of providers among a nationwide paramedic staff shortage.
We continue advocating for sustainable funding for the Emergency Medical Services that eliminates all surprise bills to patients, but as of right now in Pennsylvania EMS agencies continue to struggle to obtain fair funding. Without your community support, we would be one of the hundreds of services that have closed or merged this past decade. We hope you will see the value in continuing to support local emergency medical services and participate in our ambulance fund drive program this year.