Hatzolah Billing Insurance

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  • #1639248

    Meno
    Participant
    #1639265

    ubiquitin
    Participant

    Because it will shift it from being a volunteer ambulance to a private ambulance company.

    Now that isn’t necessarily bad there are plenty of private ambulance groups out there, but that wasn’t what Hatzolah was designed for.

    Hatzolah isn’t exactly struggling financially, it is a organization that carries a lot of panache and is easy to get funding for. billing opens a pandoras box, and will probably change the nature of the organization.

    Furthermore, billing requires charging a copay (to those, like most who have a copay for ambulance ride ) It is insurance fraud not to charge a copay (although they don’t have to collect it)

    #1639262

    jakob
    Participant

    Cause hatzolah volunteers are there to help their brethren in need of help to save lives. Once you start billing insurance you turn the entire life saving organization into a business and throw the chessed of helping your brothers away.

    I.e. if your going to bill insurance then I will just use a EMT service that is a business of providing ambulance services and other emergency help etc… Versus hatzolah volunteers acting as chessed when in truth it’s all business and their billing insurance.

    WE HELP OUR BRETHREN TO SAVE THEIR LIVES NOT TO MAKE MONEY

    #1639261

    Joseph
    Participant

    They should have been billing insurance all these past years. Better late than never.

    #1639259

    Joseph
    Participant

    Meno: Agreed.

    #1639272

    Meno
    Participant

    Hatzolah asks me for money all the time. I’m happy to support them but obviously I would prefer if they could get the money from someone else. I don’t understand why that would turn the whole organization upside down.

    Regarding the copay issue, aren’t there already some hatzolah that do bill insurance? How do they deal with that?

    #1639274

    ZionGate
    Participant

    Who gets the insurance check & who’s watching?

    #1639275

    2scents
    Participant

    There are a number of technicalities such as copays and documentation, I hope they have this all figured out.

    I do not believe that the infrastructure or the patient care side, which is what we, the public is exposed to will change one bit. Other than having more finances for better equipment and more stuff that will enhance patient care.

    They will still remain a volunteer agency regardless if they collect insurance or not.

    From what I understand Catskill Hatzolah has already collected from insurance and several other areas are doing this for many years, has that had any negative impact on their patient care, are those areas now considered ‘private’ or they are still volunteer based?

    The members are not getting paid, instead insurance is being collected to cover operating expenses and purchase of new ambulances and equipment.

    The Hatzolah model seems to have a greater cost compared to the traditional ems model, they need to outfit individual units vs just outfiting an ambulance.

    Regardless, I am not very familiar with the opposing positions and I am sure that there compelling arguments against collecting insurance money.

    #1639287

    ubiquitin
    Participant

    “I’m happy to support them but obviously I would prefer if they could get the money from someone else.”

    Exactly, I think most people are happy to support them
    so are they going to cut back their fundraising?
    Hatzalah isn’t struggling (please correct me if I’m wrong)
    where is all this extra money going to go.

    Money corrupts. Its the nature.

    I’m not opposed to it per se, It isnt the worst thing if instead of the volunteer organization it once was it becomes a private for profit organization. Which of course isnt definite, but this is certainly a HUGE step in that direction.
    I’m just explaining the tzad

    #1639347

    Amil Zola
    Participant

    I think its great that there are other hatzolah that have been billing. They serve as a model for the Queens group. No sense reinventing the wheel if the billing model already exists.

    Medical necessity is a determining factor in whether an insurance company (if covered) or Medicaid will pay for transport. Health insurance policies that cover transport will not cover a home call for Yankey’s runny nose, or Ruth swallowing a penny. For Medicaid and Medicare patients the ambulance service must meet their ambulance requirements and certifications. Just something to think about.

    #1639355

    2scents
    Participant

    Ubiquitin,

    You make valid points and I am not familiar with the structure. However you call them private and for profit, are the hatzolohs that already collect private and for profit agencies?

    Is it a bad thing that they no longer will be dependent on our donations to cover their operating budget?

    #1639433

    Joseph
    Participant

    If Hatzalah bills insurance, Hatzalah must send the patient who Hatzalah took to the hospital a bill in the mail for co-pay amount set by the insurance policy?

    #1639437

    DaasYochid ☕
    Participant

    I can think of a few arguments against billing insurance and Medicaid.

    1) By taking insurance money, particularly government (Medicaid) funds, they are opening themselves up to investigations and charges of fraud. I’m sure some will respond that they should simply follow all regulations and there won’t be a problem, but some of the regulations can be confusing and unintentionally violated, plus, a motivated prosecutor can cause trouble even when everything is legitimate. There are several such cases, some more famous than others.

    2) We don’t want insurance companies or the government having any say in how care is provided.

    3) You have to bill everyone. Aside from the legal issues of only collecting from insurance but not from individuals, people will hesitate to call Hatzala if they know they’ll be getting billed. Theoretically, it shouldn’t make a difference, but practically it will.

    #1639475

    DaasYochid ☕
    Participant

    If Hatzalah bills insurance, Hatzalah must send the patient who Hatzalah took to the hospital a bill in the mail for co-pay amount set by the insurance policy?

    Someone more knowledgeable can answer definitively, but I would imagine that not to charge anybody but those with insurance would be fraud.

    #1639477

    anonymous Jew
    Participant

    Billing is not so simple. You have to buy billing software ( it’s all done electronically) and an accounts receivable system. You also have to train the EMTs to collect insurance information from either the patient ( in most cases not possible) or the hospital/ER. The ER has to stabilize the patient before they can inquire ( EMTALA law ) about insurance and the EMTs often cannot/won’t wait. You also have to hire staff to research and resubmit denied claims.

    #1639481

    2scents
    Participant

    A. What fraud? They should have a quality assurance system like every ems system has, all documentation should be reviewed, if done properly there shouldnt an issue with fraud.

    B. Insurance does not dictate what treatment should or should not be done, they may refuse payment, yet the ems responders do not treat according to what insurance pays.

    Besides, government already controls ems treatment and protocols.

    C. I hope they have a solution to the legal technicalities.

    However this is already done for a very long time in a lot if different hatzolah systems, if it works for them, it should work for others.

    #1639484

    apushatayid
    Participant

    They implemented a policy against the explicit ruling of their posek. That is quite troubling for a frum organization. Reason enough, for him to resign.

    #1639486

    Mammele
    Participant

    One of the issues that may come up is to which hospital to take the patient to. Sometimes a better hospital for the specific issue (heart etc.) warrants a longer trip. Insurance companies (and EMS) have their rules, and I think the closer hospital usually wins.

    #1639518

    2scents
    Participant

    Mammele,

    In that case, insurance will not compensate for the transport to the distant facility and will only pay the cost of s shorter transport.

    Unless there is a justification such as a required intervention that only the further facility is able to do.

    #1639520

    2scents
    Participant

    Anonymous,

    There are billing companies that handle this, they would reach out to the hospital to obtain insurance information.

    #1639524

    DaasYochid ☕
    Participant

    if done properly there shouldnt an issue with fraud.

    Shouldn’t be, maybe, but that doesn’t mean there won’t be.

    Is it even legal to bill only insurance companies but not patients?

    #1639528

    justme22
    Participant

    Hatzalla did not have an easy time in most jurisdictions getting permits to have ambulances, I’m sure doing so for profit would make it even more complicated. A pr nightmare
    To the best of my knowledge there are no private ambulance services ( there are ambulances for mobility but not for emergencies .
    Copays would be a huge issue , if they bill insurance theyy have to bill copays collecting copays (and even worse Because e of deductibles if might be hundreds) There is not enough demand only within the community to survive.
    They are less likely to collect as much of they are charging anyone. The right thing to do if one uses the service and has the funds is to donate at least the amount you would have had to pay 911..of course even if all their patients pay there is hopefully not enough demand to pay the bills ( gas , malpractice insurance etc )

    #1639529

    DaasYochid ☕
    Participant

    In that case, insurance will not compensate for the transport to the distant facility and will only pay the cost of s shorter transport.

    In which case, there becomes an incentive to transport to the closer facility.

    #1639533

    Joseph
    Participant

    APY: Their posek is Rav Dovid Cohen, not the Rov who was opposed.

    Mammele, AJ: So they simply won’t get paid in such instances, at worst. Certainly no worse than now when they’re never paid.

    #1639541

    2qwerty
    Participant

    I heard from Hatzolah guys that if they take insurance then they have to provide care to everyone who calls them. And no matter what day of the week. And 911 may dispatch calls to their buses if they are closest to take the call.
    So it becomes a whole different company.
    My only solution to this was to have 2 companies and depends on the situation that’s the one that responds but it can get tricky and we still need city to respect Hatzolah amd help it out.

    #1639552

    DaasYochid ☕
    Participant

    My only solution to this was to have 2 companies and depends on the situation that’s the one that responds but it can get tricky

    “It can get tricky” is an understatement. It would unquestionably affect response time and overall efficiency.

    What it comes down to is that on several levels, accepting insurance is likely to have a negative affect on Hatzola’s effectiveness, as well as increase the likelihood of a chillul Hashem occurring.

    #1639550

    Joseph
    Participant

    2qwerty: That information doesn’t seem to be accurate.

    DY: Hatzalah world do what is medically prudent rather than follow financial incentives; even if they’re not paid at all for the call. Just as now.

    #1639557

    DaasYochid ☕
    Participant

    I heard from Hatzolah guys that if they take insurance then they have to provide care to everyone who calls them.

    Wait, don’t they anyway do that?

    #1639563

    DaasYochid ☕
    Participant

    DY: Hatzalah world do what is medically prudent rather than follow financial incentives; even if they’re not paid at all for the call. Just as now.

    They should, but we’re dealing with human beings here.

    #1639576

    2scents
    Participant

    Daas,

    All of this is assumptions, there are a number of other hatzolahs that collect from insurance and have been doing this for a very long time.

    Has it impacted their care to the community in a negative way?
    Do these areas base transports decisions on insurance compensation?

    If the answer is no, then these assumptions are proven to be incorrect.

    The answer is no. It so happens to be that the hatzolahs that have been collecting insurance are known to go the distance and transport decisions are based on the patients needs.

    #1639586

    DaasYochid ☕
    Participant

    The answer is no.

    Is there a scientific study on this?

    #1639592

    DaasYochid ☕
    Participant

    there are a number of other hatzolahs that collect from insurance and have been doing this for a very long time.

    Do they send bills to the patients?

    #1639600

    bk613
    Participant

    “To the best of my knowledge there are no private ambulance services ( there are ambulances for mobility but not for emergencies .”

    That is not true, at least not in NYC. There are many private ambulance companies that handle emergencies.

    “I heard from Hatzolah guys that if they take insurance then they have to provide care to everyone who calls them. And no matter what day of the week. And 911 may dispatch calls to their buses if they are closest to take the call.”

    Even now they must respond and treat anyone who calls them. They would get in tremendous trouble if they did not. They will never be dispatched by a 911 dispatcher because they are not part of the FDNY system. That has nothing to do with being a volunteer company.

    #1640126

    apushatayid
    Participant

    I guess joseph knows better than the article that quotes mr. rowe as saying rav kalman epstien is the mara d’asra of queens hatlzalah.

    #1640134

    Joseph
    Participant

    APY: How dare anyone doubt or question what the article says! I mean its written starkly in black and white, so the journalism must never be doubted. And, no doubt, if Mr. Rowe did say that it too must be absolutely true and unquestionable since… he said it.

    #1640144

    2scents
    Participant

    DaasYochid,

    “What it comes down to is that on several levels, accepting insurance is likely to have a negative affect on Hatzola’s effectiveness, as well as increase the likelihood of a chillul Hashem occurring.”

    Why do you say so?

    This has been done by many different Hatzolahs yet there has been no change on the side of patient care, this is only on the financial end.

    Furthermore, at times Hatzolah would ‘privatize’ transports, this usually occurs when they cannot get members to respond to a call, now there will be an incentive for those that manage the organization to have sufficient coverage and cover all calls, otherwise it means a loss of revenue and more difficult to cover their operating budget.

    again, the members will still be volunteers, the structure and character would not change. Only instead of completely relying on funds from the community, they will get much more by collecting insurance money that is already there, it only needs to be collected.

    I am not dismissing the argument on the opposing side, I have no clue about the specifics and it may very much be that there are valid reasons against billing insurance for transports that they already do, I just have just not yet heard a valid argument.

    #1640142

    2scents
    Participant

    If the primary reason as to why Mr Rowe is stepping down was due to this being against daas torah, this would be a very valid reason and Mr Rowe should have said so, not just mention in passing reference that Rav Epstien also holds of his opinion.

    #1640171

    apushatayid
    Participant

    joseph, if you believe the article on YWN is wrong, the reporter is wrong, mr. rowe is wrong, or is misquoted, why didnt you say so from the moment it was cited?

    we can also say, that if rav epstier is mr. rowes rav, and he believes it should not be done, then mr. rowe is following the advice of his rav. he isnt forcing the organization to follow his personal rav.

    im sure joseph will tell me that he knows mr. rowe davens elsewhere, and has a diferent rav. in fact, he knows someone else who is really mr. rowe and the one quoted in the article is an imposter.

    #1640682

    Amil Zola
    Participant

    Where I live many small towns have volunteer emergency services. Some of these groups are a set up as nonprofits and still bill ins. It doesn’t seem so different than Hatzolah in larger cities. Others that charge for services do not bill ins. companies but expect payment to be rendered by a responsible party and that party can then file for reimbursement from their carrier.

    #1640703

    anonymous Jew
    Participant

    Hospitals are nonprofits that bill insurance companies

    #1640757

    Neville ChaimBerlin
    Participant

    I still have yet to see a rational reason why billing insurance would be bad. Also, it seemed from the article that it’s already how every Hatzolah other than Queens works. EMT’s are not paid on commission (if they’re paid at all) so the assertion that they would prioritize based on economics is ridiculous.

    I’m inclined to go with apushatayid, though. Going by the article alone, it seems like they did something their posek told them not to do. I thought the article did a poor job explaining why the Rav or anyone took that stance, which is why it’s up for debate now. There must be something we’re missing here.

    #1640810

    ubiquitin
    Participant

    “I still have yet to see a rational reason why billing insurance would be bad. ”

    reread the thread several have been given

    now you are of course free to disagree (as many at the top of Hatzolah do, ) .

    I am not saying it is a open and shut case. There are without question good tzedadim on both sides (I think all agree to this (keep in mind even the “branches” that have been billing, is all relatively recent for years even they were opposed) the question is which outweighs the other

    anonymous
    “Hospitals are nonprofits that bill insurance companies”

    Exactly! and it would be a loss if Hatzolah started functioning like hospitals where the number one concern is the bottom line. Again, that isnt to say that this would be the worst thing in the world.

    #1641097

    DaasYochid ☕
    Participant

    I haven’t gotten an answer to my question:

    Do the branches of Hatzalah which bill insurance send bills to the patients’ home?

    #1641118

    Joseph
    Participant

    From what I’ve learned, it seems that the insurance contracts that providers must agree to in order to be paid from insurance money requires that they make a good faith effort to bill the patients for the copay set by the policy.

    #1641119

    bk613
    Participant

    I feel like hatzola should lay out their new guidelines for billing to the community. Have any of tthe neighborhoods where they bill done this? Will the neighborhoods that are starting make a formal statement? People have the right to know. Hatzolah is (or was) a community funded organization and the community should be notified of any drastic changes.

    #1641177

    Joseph
    Participant

    2scents: How often does it occur that Hatzalah cannot get any member to respond to a call and instead calls a private ambulance company to take the call?

    Does this delay the response? Why can they not get any member to respond — does it only occur in non-heavily frum neighborhoods?

    #1641394

    Neville ChaimBerlin
    Participant

    “Money corrupts” is not a rational reason, nor is any other reason given here. I’m not saying the opposition has no basis; they obviously do. I just don’t think it’s been brought up here.

    I think the main question is DY’s question. Would the patients be charged the copay now? Copays for ambulances can be in the hundreds. From my limited understanding, if they bill the insurance, the patient will automatically be charged the copay. So, I guess the only way around it would be for hatzolah to actually give the patient the lump of cash they need to pay it if they aren’t able. But, like I said, I don’t know much about this.

    #1641522

    apushatayid
    Participant

    “How often does it occur that Hatzalah cannot get any member to respond to a call and instead calls a private ambulance company to take the call?”

    Often, I have a family member who works for a private, for profit, ambulance company and he gets dispatched to calls handled by hatzalah daily.

    Another question to ask is: How often is a responding member asked “can you drive me to my doctor” (often a trip from brooklyn into manhattan) in a non emergency situation (many times daily in fact) and member cant accommodate the request (nor should they quite frankly, they are emergency 1st responders, not medical transport company).

    #1641600

    ubiquitin
    Participant

    ““Money corrupts” is not a rational reason,”

    I know you are but what am I.

    If you need it explained in more detail, I’d be happy too (as always) no need for blaket dismissals of other opinions. Right now Hatzolah is strictly a chesed organization. The sole reason for its existence is to help the klal (True some members join for the glitzy lights and the hock, but by and large it exists for chesed)

    Once they start making money the motivation will change (not may, it will) this is guaranteed. Whether this will negatively affect patient care, I concede that it may not (as I said earlier) but once it starts making money there will be pressure to cut corners and make more money. Thus, if it functioning well now (whcih it is as it has over the past decade) why turn it into a money making machine.

    #1642000

    2scents
    Participant

    ubiquitin,

    They currently are making money, all these fundraiser events and donations.

    I do not think that anyone is implying that they will not have profits which means monies that exceed their expenses.

    Hatzolah has a grassroots response, which means they need to outfit each member with a complete set of gear and medications, most of these have expiration dates and require preventive maintenance and repairs. This is an expense that the average ambulance service does not have.

    I am under the assumption that these monies will cover their operating budget yet they will still need to purchase ambulances. I do know that agencies that collect insurance money still need grants to purchase ambulances it is not like there is excess money, it just helps enormously cover their day to day expenses.

    I do wonder if someone is able to shed light on the technical questions such as copays and billing to those without coverage, I am sure something has been worked out as other hatzolahs already are billing for years and Central hatzolah has already done so in the Catskills.

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