Yes. The EMSAcare program does not provide benefits for pre-scheduled non-emergency transports without a physician certification statement. Also, repetitive transports for services such as dialysis, radiation therapy and chemotherapy are not included. EMSAcare 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.
Do participating customers receive benefits for non-emergency transports, too?
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% 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 EMSAcare.
I have an active EMSA EMSAcare membership. What does this mean for me?
Your membership will automatically renew each year unless you contact the City of Oklahoma City from Sept. 1-30 at (405) 297-2833 and opt out of the program.
I have insurance and/or Medicare. Why should I participate? (Isn’t it like I’m paying for the same thing twice?)
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 full billed charge of $1,300 plus $9 per mile. Even when insurance/Medicare approve claims, many people still have a financial burden – a $50 to $250 deductible, a 20% 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.
I have Medicaid. Why should I participate?
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.
I live at ABC Apartments. I want to opt out.
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.
I live in Midwest City, Harrah (or other community not in EMSA’s service area). What does this mean for me?
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.
I live outside of Oklahoma City but receive an Oklahoma City utility bill. What does this mean for me?
Only water customers residing within Oklahoma City limits are eligible to participate in Oklahoma City’s program. Some other cities served by EMSA have or are creating similar programs.
I own/operate a nursing home/assisted living facility. What does this mean for us?
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. For information, visit EMSA's website or call 405-396-2888.
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?
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.
I pay the EMS fee at my home, but my husband lives in a nursing home. Does he need a separate membership?
No. A participating utilities customer does not need to purchase a separate membership for a spouse in a nursing home.
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?
EMSA is Oklahoma’s largest ambulance service, providing care in 16 communities (Oklahoma City, Edmond, Mustang, Nichols Hills, Piedmont, The Village, 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.
I’m opted in and had an emergency EMSA transport, so why am I getting a bill?
Every patient will receive a statement from EMSA after an ambulance transport. Please read the statement carefully. You may not owe anything and it is simply notifying you of the amount EMSA will bill your insurance provider. In many cases, EMSA is requesting your insurance information. You must submit your insurance information to EMSA to have your costs covered by EMSAcare.
If you do not have Medicare, Medicaid or other insurance, please notify EMSA as soon as possible.
If your ambulance transport will be covered under another policy, such as a motor vehicle policy (in the case of motor vehicle accidents), the Crime Victim’s Compensation Fund or other third party, please notify EMSA as soon as possible.
If I opt out but later change my mind, can I resume participation?
Customers may change their election only during the annual September election period.
If I opt out next September will I have to opt out every September?
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.
If I participate, who is covered?
This program is offered to Oklahoma City residents only. 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.
If I pay the utility fee, will you bill my insurance?
Yes. EMSA has and will continue to bill any third-party insurance payors. More than 80% of EMSA’s revenue comes from third-party insurance payments, such as Medicare, Medicaid, private health insurance and others. It would be unfair for taxpayers to bear the burden of healthcare costs that could be otherwise covered by insurance providers.
Then what is the utility fee for?
The utility fee is a convenient way to cap an individual’s expenses on ambulance costs. It covers out-of-pocket costs you would normally have to pay beyond what your insurance pays, such as deductibles and co-payments.
What about people who don’t have insurance?
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. Those EMSAcare members without insurance who are transported by EMSA must alert EMSA that they have no insurance when contacted by EMSA following their transport.
What are my responsibilities when transported by EMSA under EMSAcare?
Your EMSAcare benefits will be honored if you need an EMSA transport in the following cities:
Also, transports from Tulsa, Sand Springs, Bixby or Jenks
(cities also served by EMSA) to a hospital in Tulsa would be covered.
Cities in the metro area that are not served by EMSA:
What constitutes a non-emergency transport?
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.
What constitutes an emergency transport?
An emergency transport occurs any time EMSA transports you to a hospital emergency room for urgent, unscheduled treatment of an unforeseen medical condition.
What do I need to do when I get a bill?
Approximately 10-15 days after your transport, you should receive a letter from EMSA requesting the name of your insurance provider. Your insurance provider is responsible for payment of ambulance services. Your EMSAcare membership covers all out of pocket expenses associated with your ride – expenses not covered by your insurance policy. Once you receive the letter, you will have 60 days to provide EMSA with insurance information, even if you do not have insurance, pertaining to yourself or anyone living in your household covered by EMSA. Failure to provide the information nullifies your membership.
What if I need an ambulance while on business in Tulsa?
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.
Where can I read the ordinance?
Log on to the City website at okc.gov. On the top menu, you'll see Municipal Code in the Government menu. Click the link, then just type the Ordinance number, 23,765, in the search engine.
Why is this necessary?
The City of Oklahoma City currently funds ambulance service through our general fund, which is the same way we pay for street maintenance, many public safety programs and other expenses. Funding ambulance service through a special fee frees up general fund tax dollars for other community needs. And, in return, citizens will receive EMSAcare benefits.
Will EMSA still sell EMSAcare memberships directly?
Yes, for people living in nursing homes and in apartment complexes that opt not to participate, and for those living outside of city limits.