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People with no insurance have a hard time paying for their use of the Roane County ambulance service.
“I think it’s 13 percent of our total transports are non-insured, and most of those accounts are delinquent,” said Howie Rose, director of the county ambulance department.
The uninsured could have an even harder time paying in the future.
The Roane County Ambulance Committee is recommending a rate increase.
“We’re leaving a lot of money on the table,” Chairman James Brummett said.
The proposal, which was passed by the committee earlier this month, is to increase the basic life support nonemergency base rate by $150 and the basic life support emergency base rate by $70.
The advanced life support 1 emergency base rate would increase by $75 and the specialty care transport base rate would increase by $200.
The committee is also recommending the mileage rate increase by $1.12 per mile.
“We looked at five other EMS agencies of like size and kind and took an average of their rates,” Rose said. “Then we looked at what was the Medicare allowable and the TennCare contractual number, and this is how we came up with this.”
Rose and his boss, Roane County Executive Ron Woody, said the county is not billing what is allowed under Medicare.
“We can get more money based on the Medicare allowable than what we’re getting now,” Rose said.
“We’re not billing enough to get all that the federal government will pay us,” Woody added.
Commissioner Ron Berry was the only one on the committee to vote against the proposal to increase the rates.
“Can we just raise Medicare rates?” he asked.
Rose said that wasn’t an option.
“It don’t work that way, unfortunately, because what you do then, you’re singling out one payer class,” he said. “You have to raise them across the board.”
The recommendation is expected to be on the commission agenda in November. The commission voted down a proposal to increase the ambulance rates in February.
The ambulance committee also voted to put in place an aged-account policy.
“What our aged-account policy says is that after we have tried to collect this account and it’s reached 90 days, we’re going to turn it over to the collection agency,” Rose said.
The account will stay with the collection agency for 18 months. If the collection agency cannot get the person to pay, the account will be turned back over to the county for legal action or to be written off.
“We got about 1,200 accounts that are greater than 90 days old, and they are just sitting there,” Rose said. “They’re not being actively collected upon the way that they should be and that represents about $875,000.”
Woody said the county will not turn the account over to collections if payments are being made.
“If they’re making payments on it, it’s not aged,” he said. “It doesn’t fall in the policy.”
The committee also approved an account write-off policy.
It says anything less than $5 will be written off automatically. In the case of a deceased patient, the county will write off the full balance of the account, provided there is no estate and a death certificate is provided.
County employees injured on the job and “certified” members of volunteer fire departments and rescue squads hurt while responding to an emergency also may be written off.
The county will also write off some debts in what the policy calls “financial hardship” cases.
Woody said the account write-off and aged-account policies do not need commission approval, so they are already in effect.
Rose said a lot of what’s in the policies came from other agencies.
“Instead of reinventing the wheel, we kind of went out there and looked to see what everybody else was doing,” he said.
Berry voted no on the policies.
He said he thought the committee was moving too fast.
“I guess my problem is we’ve got an urgency and haven’t met for six, seven months,” he said, “and all of a sudden tonight we come in here, and we’re going to sit down and vote on all of it, bang, bang, bang.”
Rose said the policies were vetted with County Attornery Tom McFarland, Woody and consultant Jack Jinks.