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. I don’t get anything by participating. (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 charge of $719.71 plus $9 per mile. Even when insurance/Medicare approve claims, many people still have a financial burden – a $50 to $250 deductible, a 20 percent co-payment like 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: Do participating customers receive benefits for non-emergency transports, too?
A: EMSA non-emergency transports are fully covered 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 percent 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: 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: 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: Only during the following September. 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 EMS 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 EMS 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 live at “ABC” Apartments. I want to opt in.
A: If your landlord does not opt out of the program, you will receive benefits. However, even if your landlord opts out, you may purchase a TotalCare membership for your own family directly from EMSA. You can call EMSA at 396-2888.
Q: How is the fee calculated for multi-family customers?
A: It’s the number of residential units at the property multiplied by .5. The .5 number was chosen to reflect variances in occupancy and tenant turnover. The resulting figure is rounded down to the lowest whole number. For example, if there are 95 units at your complex, 95 times 0.5 is 47.5 – so the lowest whole number is 47. Then, Utilities Customer Services would multiply 47 by $3.65 – that’s what the monthly fee would be.
Q: I have an active EMSA TotalCare membership. What does this mean for me?
A: Your membership is set to expire after June 30, 2009. The Oklahoma City utility bill program won’t go into effect until September 1, 2009. EMSA is working on a plan to ensure that there’s no gap in coverage for current members. You won’t have to pay both the City and EMSA, though.
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, Nichols Hills, 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 about 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 Oklahoma City from Tulsa would NOT be covered – as it would result in the ambulance leaving the service area during the transport.
Q: I live outside of Oklahoma City but receive an Oklahoma City utility bill. What does this mean for me?
A: Only those water customers residing within Oklahoma City limits are eligible to participate.
Q: I live in Midwest City, Harrah (or other community not in EMSA’s service area). What does this mean for me?
A: EMSA does not service your community, so this does not affect you – except that if you need service while in Oklahoma City, you can rest assured that you will receive the highest quality of EMSA care.
Q: Why is this necessary?
A: Currently, the City of Oklahoma City funds ambulance service via our general municipal fund, which is the same way we pay for street maintenance, many public safety programs and other expenses. Funding ambulance service via a special fee will free up some general fund tax dollars for other community needs. And, in return, citizens will receive TotalCare benefits.