SRAS reaches out to patients about insurance challenges
The Spring River Paramedic Ambulance Service [SRAS] in Sharp County is reaching out to their patients and potential patients in regards to some challenges in healthcare coverage they have identified recently.
According to Jennine Eash Business Operations Director for SRAS, for many years, Medicare has been the largest insurance provider in the area, however, more recently, with expansions in healthcare, Medicare Advantage programs have been created, and some individuals are opting to use the newer programs.
In the area SRAS covers, there are typically four Medicare Advantage Programs. Typically, when it comes time to reenroll, patients may choose Medicare, however, representatives from the Medicare Advantage plans also make presentations to those making the decision as to which coverage option they will choose.
Eash explained that although the premiums may be lower with the Advantage programs, the services considered to be “out of network” are not well explained. As a service, SRAS is considered to be one of the out of network by the Advantage plans, leaving the burden of payment on the patient.
Eash said as the ambulance service has been tracking payments, they have noticed patient advantage program insurer co-pays are significantly higher.
“With traditional Medicare, the patient’s co-pay is anywhere from about $47 to $128. It varies but usually decreases over time if the patient has to use the ambulance service multiple times. With these Medicare Advantage programs though, people’s co-pays are $200 to $350 every single time they used the ambulance,” Eash said. “There is a doctor’s office I go to and they are no longer accepting WellCare because of the problems they are having. One of the problems they are having is, people use the ambulance and go to the ER or go to the ER and the doctors transfer them to wherever, such as White River or St. Bernards. The Medicare Advantage programs are saying we’re not coding it correctly or it’s out of network, but these are all claims traditional Medicare would pay.”
Eash said SRAS has fought long and hard for many of their patients to have the claims put through, however, it has been a losing battle and with the new enrollment period approaching, the service wants to let their patients know there will be changes in the immediate future.
“We want to make people aware. The issue we’re getting into is we have asked for codes they would accept that we can use [for billing]. We bill everything with Medicare approved codes because we are regulated by Medicare. We’re using Medicare approved codes and they [Advantage plans] are still denying them. We’re appealing them but we want people to be aware, if they decide to keep their Medicare Advantage programs, we will bill their advantage program, but we will not be appealing them anymore. It’s not cost effective and they are still not paying the appeals,” Eash said. “We’ve done everything we can. We’ve called them, sent letters, sent e-mails. Our main concern is to help our patients the best we can, and our biggest problem right now is WellCare or Harmony [ a sister company]. We have requested the list and they won’t do it.”
Eash said the difference in reimbursement rates is a drastic one. For example, if SRAS sends 10 claims to Medicare, 10 of 10 or occasionally nine of 10 are typically paid. When claims are sent to the advantage program providers, typically one in 10 are paid and the other nine must be appealed.
“When they do pay, it isn’t much and the co-pay for the patient is the same every time. It’s a minimum of $200 every time these people have to take an ambulance. My suggestion is to stick with traditional Medicare because it will cover more, at least for Part B and we are Part B. I want to encourage people to really take a good look at their plans while they can. Ever since they began offering the advantage programs, we’ve tried to work with them and its to the point they’re just not paying,” Eash said. “We’ve tried to help our patients and we’ve appealed it and they’ve appealed it and we’re seeing patients having to pay these bills out of pocket because the advantage plans aren’t covering them. We will send in the initial bill for anybody, we just want people to be aware.”