EMSA TotalCare

[Hondo1]

FYI, the EMSA "Total Peace of Mind Care" coverage being offered to OKC residents for $3.65 a month, I feel, is somewhat deceptive. I queried a customer service rep and learned that the fee pays only for transportation; not for any treatment and / or supplies administered by paramedics. I'm not saying it's a bad deal but when I think "Total" I assume...."total," which this is not.

[metro]

Better than paying what was it $800 or so for transportation

[hipsterdoofus]

Better than paying what was it $800 or so for transportation

Unless you never use it - don't know if OKC is doing the same way Edmond is, but I feel it should be an opt-in, not an opt-out.

[EBAH]

Yeah but if you are going to offer the service at all, it kind of has to be everyone. If you could just opt out it seems to me that it would defeat the purpose.

[BoulderSooner]

Yeah but if you are going to offer the service at all, it kind of has to be everyone. If you could just opt out it seems to me that it would defeat the purpose.

you can just opt out .... but that is his point .. you have to opt out ... you don't have to opt in

[kevinpate]

IF memory serves from various commercials over the years, the ambulance folks offered an opt-tin, sorta. A family could pay a low annual subscription fee (40?, 50?) and their needs were covered.

Apparently that wasn't doing the solvency trick. If I were designing the program, I'd make it opt-out instead of opt-in. Not many folks require the service, but many will look at a small monthly charge and shrug it off as not worth the trouble to opt-out, without ever seriously considering what makes the most sense for them. If the goal is to fund it well, make it opt-out is definitely the better dobber choice for them.

[PennyQuilts]

Yeah, we figure the three plus bucks a month wasn't going to break us. And since we are now in our fifties, who the hell knows what sort of ailment might pop up. I could get a bad case of malaria or something.

[hipsterdoofus]

I think the whole point is they are hoping people don't pay attention to the increase in the bill and thus never opt-out. Kind of sneaky if you ask me.

[OKCTalker]

They're doing the same thing in Nichols Hills. A $2.50 fee is added to the monthly water bill. If EMSA transports you, you're not out of pocket for the ride, but they will then seek reimbursement from any applicable insurance policy you may have. And according to a city council member, "Nichols Hills has to pay a huge fee to EMSA every year to come to NH."

So EMSA has three sources of revenue: Monthly from the residents, annually from the municipality, and after-transport from the resident's insurer.

If they can't operate in the black with this revenue scheme, they should be put out of business.

[Patrick]

Yeah, there will be an option to opt-out if you wish. But, it will be your $800 bill if an emergency comes up.

[hipsterdoofus]

Yeah, there will be an option to opt-out if you wish. But, it will be your $800 bill if an emergency comes up.

Thats what savings are for - but apparently people don't have the control to keep savings anymore.

[Platemaker]

Yeah, there will be an option to opt-out if you wish. But, it will be your $800 bill if an emergency comes up.

Even if you never had to take an ambulance it would be 219 years before you paid out $800 bucks... I'd say the fee is well worth it.

[Patrick]

Thats what savings are for - but apparently people don't have the control to keep savings anymore.

It would take 20 years, based on $3.65 a month, to earn $800. Chances are good you'll need an ambulance at least once during that time.

[Platemaker]

Wow.... my math! YIKES!

[hipsterdoofus]

It would take 20 years, based on $3.65 a month, to earn $800. Chances are good you'll need an ambulance at least once during that time.

I'd like to see a statistic on that - chances are you are paying for someone else's multiple trips instead. I know plenty of people in their 60's who have never been on an ambulance.

[Patrick]

Chances are you are paying for someone else's health problems when you buy health insurance.

Chances are you are paying for someone else's accidents when you carry car insurance.

Chances are you are paying someone else's dividends when you buy life insurance.

Chances are you are paying for someone else's house to rebuilt when you buy insurance for your home.

I know plenty of people in their 60's who have never used any of the above insurances for any major amounts but still carry them.

[andy157]

They're doing the same thing in Nichols Hills. A $2.50 fee is added to the monthly water bill. If EMSA transports you, you're not out of pocket for the ride, but they will then seek reimbursement from any applicable insurance policy you may have. And according to a city council member, "Nichols Hills has to pay a huge fee to EMSA every year to come to NH."

So EMSA has three sources of revenue: Monthly from the residents, annually from the municipality, and after-transport from the resident's insurer.

If they can't operate in the black with this revenue scheme, they should be put out of business.

They have locked themselves in pretty tight with both OKC, and Tulsa. People complain about the recent auto/bank bailouts. EMSA has been receiving taxpayer bailouts from the first day they came to town. I will say this for them, and you have to give them credit, their ability to have the taxpayers fund their Private(profit)/Public(expense) business model has worked well.

[hipsterdoofus]

Chances are you are paying for someone else's health problems when you buy health insurance.

Chances are you are paying for someone else's accidents when you carry car insurance.

Chances are you are paying someone else's dividends when you buy life insurance.

Chances are you are paying for someone else's house to rebuilt when you buy insurance for your home.

I know plenty of people in their 60's who have never used any of the above insurances for any major amounts but still carry them.

But in this case you have a choice, don't you? Instead of relying on the city to babysit you, you could just save the money up for yourself and not have to worry about the cost if it happens.

OOOOH its only $3? That kind of adds up eventually. Would rather spend it on something than nothing (or welfare).

[Patrick]

But in this case you have a choice, don't you? Instead of relying on the city to babysit you, you could just save the money up for yourself and not have to worry about the cost if it happens.

OOOOH its only $3? That kind of adds up eventually. Would rather spend it on something than nothing (or welfare).

You have a choice with almost any of the above insurances, except car insurance, and even then you have a choice on what coverage you want. Instead of relying on Blue Cross Blue Shield to babysit you, you could just save the money up for yourself and not have to worry about the cost if it happens. Same thing with homeowners insurance. Or life insurance.

[Buickcarnut]

The other sneaky thing is your locked in for at least a year and they are only giving people a month to opt out with little notice about what is going on. These companies are not stupid, most people won't bother opting out because people are lazy, forgetful or just don't want to deal with the process of opting out, so they are counting on that. When you take the $3.65 times 228,000 houses 07 data (Oklahoma City, OK (Oklahoma) Houses, Apartments, Mortgage Status, Home and Condo Value Estimator, Cars, and Residents Info), that equals about $832,000 per month or $9.98 million a year. Now lets say 30% opt out, about 68,400 homes, so now that leaves 159,600 homes in Oklahoma County. Now they receive $582,540 per month or $6.99 million for the year.

Now here's some interesting reading, http://www.ok.gov/health/documents/G...l%20Report.pdf

I'd like to know a few things. Who came up with the monthly amount, and how is the money going to be spent? I for one would want to see accountability for these funds since I now consider this public money helping a private company.

By the way, read the fine print.....

Membership Agreement and Description

TotalCare is an ambulance service subscription program sponsored by the Emergency Medical Services Authority (EMSA). TotalCare provides for the prepayment of co-payments and deductibles for all medically necessary ambulance services for which the patient (or his or her insurance provider) has financial responsibility. In addition, TotalCare members pay a reduced rate of 40% off the regular cost of non-emergency transports.

The TotalCare 2009-2010 eastern division open enrollment period ends on June 30, 2009. All 2009-2010 eastern division memberships expire on June 30, 2010. The TotalCare 2009-2010 western division open enrollment period ends on September 30, 2009. All 2009-2010 western division memberships expire on September 30, 2010. Individuals who join after the enrollment period are eligible to receive benefits for dates of service 30 days after payment is received in full.

Who Is Covered?

One membership covers the applicant and all permanent members of the applicant’s household. A spouse being cared for in a nursing home may be covered under the applicant’s membership. In many communities, a small monthly fee is added to most residential water/utility bills to support ambulance operations and provide benefits. TotalCare is designed for those individuals living in nursing homes and apartment complexes not participating in a city utility bill program.

If you have questions about an individual’s eligibility, please call 396-2888 before submitting your application.

TotalCare annual membership fee: $45

Member Benefits

TotalCare membership benefits are applied to emergency and non-emergency ambulance transports provided by EMSA within the EMSA service area. Patient preference usually determines to which hospital the patient is transported; however, in cases of life endangerment, the closest appropriate hospital will be used.

Emergency transports are fully covered. An emergency is defined as an unforeseen condition that requires urgent and unscheduled medical attention. Emergency transports always result in the ambulance taking the patient to a hospital emergency room.

Non-emergency transports are fully covered if insurance or other third-party coverage provided benefits for the service (even if subject to deductible, co-payment or co-insurance). If no insurance or other third-party coverage is available or if the claim is denied, the TotalCare member is charged a reduced fee (40% off EMSA’s standard non-emergency rate). A non-emergency transport is a medical transfer that does not have a hospital emergency room as the final destination.

Excluded Services

TotalCare members must present a completed physician certification statement (PCS) to receive benefits for non-emergency transports. TotalCare provides no coverage for non-emergency transports without a PCS. The patient’s physician usually completes certificates.

Repetitive transports for services such as dialysis, radiation therapy and chemotherapy are not eligible for TotalCare benefits without additional screening and insurance approvals.

TotalCare does not cover non-emergency transports to and from doctors’ offices, dentists’ offices, physical therapy centers, pharmacies, freestanding clinics and other facilities. Transports outside of EMSA’s service area are also not included in the program. Members will receive a full bill for excluded services. Before requesting non-emergency service, please call 396-2888 to determine the transport’s eligibility.

Agreement

I acknowledge that my insurance provider and/or I am responsible for payment of ambulance services provided to me by EMSA. I acknowledge that it is my responsibility to provide EMSA with insurance and third-party payer information pertaining to me or anyone living in my household who receives EMSA services and that failure to do so nullifies this agreement. In consideration for payment of the membership fee, I hereby assign to EMSA all ambulance benefits that any covered family member or I may otherwise be entitled to receive from any insurance or other third-party payer for services provided under my TotalCare membership. EMSA will accept this assignment as payment in full for emergency transports, and for non-emergency transports if insurance or other third-party payer coverage provides benefits for the transport. I understand that EMSA will file my ambulance insurance claims for each covered person and is entitled to receive payment from all insurance or other third-party payers up to the amount of EMSA’s usual charges. If no insurance or other third-party payer benefits are available or if the insurance company or other third-party payer denies payment for non-emergency service, I understand that I will remain responsible for payment of EMSA’s reduced fee for TotalCare members (40% off EMSA’s standard non-emergency rate). Any insurance or other third-party payment I receive related to EMSA’s services provided under my TotalCare membership must immediately be delivered to EMSA, if there is an outstanding balance on my account. Violation of the terms of this agreement will result in termination of this agreement, and the patient (or responsible party) will be billed for all charges related to services provided.

[bombermwc]

Yeah the kicker is those of us with with insurance end up paying for something we won't ever have to worry about. I was under the impression that OKC's was one you had to sign UP for. Isn't that what the news was saying?

[Karried]

I received a Post Card saying that $3.65 will automatically be charged to your utility bill unless you opt out. (By Sept 30) Log on www.okc.gov/totalcare to Opt Out or call 405-297-2833

I'm keeping it, with our crappy health insurance & two active teenagers, an ambulance ride is the last thing I want to pay for.

Just wondering, suppose a friend is over at my house and gets injured. He has this Total care coverage at his home as well.... I wonder if they would cover it?

[metro]

Ambulance ride in Oklahoma County typically costs between $750-$1200. EMSA spokesperson on the news the other day stated average was $1100.

[SoonerDave]

Yeah, there will be an option to opt-out if you wish. But, it will be your $800 bill if an emergency comes up.

Many employers (mine included) have distributed flyers to their employees pointing out whether their insurance covers ambulance service. I, fortunately, have not needed such services, and was happy to discover that our company insurance covers such services 100%.

I'd encourage everyone to make a similar check with their own providers/employers to see if they're in a similar situation.

[SoonerDave]

Yeah the kicker is those of us with with insurance end up paying for something we won't ever have to worry about. I was under the impression that OKC's was one you had to sign UP for. Isn't that what the news was saying?

NO!!! To AVOID the charge, you must EXPLICITLY OPT OUT by Sep 30