The Township Council unanimously approved an ordinance that would allow West Windsor to bill for EMS services after township officials were able to bring the township’s volunteers on board with the idea.
The council also agreed to include language in the ordinance that would require a copy of the ordinance to be sent to each insurance provider — a compromise that quelled Councilman Charles Morgan’s concerns that the township was setting itself up for insurance fraud claims.
The ordinance, adopted April 6, permits the township to bill third-party insurances for ambulance services that are provided from 7 a.m. to 7 p.m. Township residents will not be charged directly for service.
Township officials estimate that the new law can generate some $200,000 in revenues annually.
At the same time, Business Administrator Robert Hary also announced that the township would be helping its volunteers from the fire companies and “Twin W” first aid squad assemble a brochure explaining to residents and potential donors that the organizations will not reap the benefits of the new revenue.
Members of the first aid squad, including President Michael Leahy, originally spoke out against the proposal, saying that the volunteers’ fund drive would be severely damaged because donors might be confused by the new billing procedures.
Leahy and Twin W Chief Sean Kehler spoke during the meeting, commended Hary, Emergency Services Director Jim Yates, and Police Chief Joseph Pica for their “receptiveness” to the volunteer squad’s concerns. He said the ordinance was discussed further at a public safety meeting.
Still, Leahy acknowledged that the new measure “will have an impact on our fund drive.” If that impact is severe, “we will have to go for billing.”
Members of the rescue squad are launching a campaign to ensure township residents know that the volunteer squad will not bill for expenses associated with any of their calls. The volunteers respond to calls Monday through Friday from 7 p.m. to 7 a.m. and on secondary calls when the paid staff is working.
Also, as part the compromise, officials added a minor language change in the ordinance to clarify operational command authority.
According to the ordinance, the township will contract with a professional medical billing service for the collection of payment for services by the township’s fire and emergency services personnel. The bill will be issued to the insurance company for the person served, if any, or directly to that person if insurance coverage is not available.
The ordinance also sets up the fees that will be charged for service. For ambulance transportation: $600. Other charges include $14 per loaded mile for basic life support; $75 for oxygen administration; $75 for automatic external defibrillator pads; $25 for cervical collars; $1,000 for motor vehicle extrication; $250 for first responder engine response; and $150 for fire responder response.
If a resident requires an ambulance or emergency response, the resident’s insurance carrier will be charged. The resident, however, will not be responsible for covering the co-pay, nor will a resident without insurance be forced to pay the entire bill.
Morgan worried that the township could be accused of committing fraud by submitting claims for ambulance and emergency services for non-residents, but not charging township residents. He was also concerned that the township could misrepresent the “usual and customary” charge in waiving the fees for residents.
For example, Morgan said, in the insurance industry, a doctor who charges a fee of $100 for a visit cannot waive co-pays for one patient and not another. If one patient has a co-pay of $20, he cannot waive the fee for that person, but continue to accept it from another. If he does, the “usual and customary” charge then becomes $80. Therefore, patients who have a 20 percent co-pay will only be responsible for paying $16, because he previously accepted a payment of only $80.
Officials said that federal regulations allow municipalities to waive the charges under the argument that residents already pay taxes for the services. They also pointed to other towns in most of the county that have similar ordinances, and who have not had problems with fraud.
Under the terms of the ordinance, if a township resident does not have insurance, the township covers the cost. If a township resident has insurance, the town won’t charge the balance.
Morgan originally suggested including language in the ordinance that states that the township would provide full disclosure of amounts waived for residents or those who are uninsured. However, he was amenable to including language that simply required the ordinance to be sent to all insurance providers, as suggested by Township Attorney Michael Herbert.
