Hatzolah Billing Insurance

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  • #1642029

    Neville ChaimBerlin
    Participant

    Ubi:
    Despite the fact that it’s been specifically addressed on this thread, you seem to be under the impression that Hatzoleh is becoming for-profit. They are not. They would simply be getting money from insurance instead of totally from donors. This is money they need for operations, not profit.

    Before you try to somehow spin it that you didn’t mean that, let me point out this quote of your’s: “once it starts making money there will be pressure to cut corners and make more money.” There’s no way that quote is not assuming they are after profit. That’s not a difference of opinion, that’s just you being wrong. They are remaining non-profit. End of story.

    I have faith that the posek who opposed the insurance had real reasons. Not emotionalist, idealist opinions like “money corrupts,” and a complete lack of understanding of what the change means.

    If currency has this otherworldly power to make its beholder evil, maybe you should publicly advocate that people donate less to Hatzolah. Wouldn’t want them to become corrupt, right?

    #1642114

    Formerla
    Participant

    If hatzolah bills it may cause then problems financially. First of all today people have large deductibles. Would they have to pay out of pocket? Second of all if the billing doesn’t cover all their expenses won’t it be harder for them to fundraise if people know they bill insurance?

    #1642141

    puttinginmy2cents
    Participant

    Copays are billed by the doctor or hospital, directly to the patient. The insurance company does not bill the patient. The doctor or hospital, or in this case, the ambulance company (Hatzoloh), will bill the patient if they want to collect the copay. I have received bills for the copay from doctors and hospitals, but never from Hatzoloh.

    #1642157

    Gadolhadorah
    Participant

    Is anyone aware of any studies which have examined whether EMS unit seeking insurance reimbursements may have the indirect effect of discouraging the use of 911 by those w/o insurance and fearful that they might be held personally responsible for the cost of transportation to a hospital ER? At times of medical stress, individuals who are not familiar with the medical care payments/insurance system might incorrectly believe they could be held responsible for hundreds of dollars of ambulance costs.

    #1642163

    DaasYochid ☕
    Participant

    At times of medical stress, individuals who are not familiar with the medical care payments/insurance system might incorrectly believe they could be held responsible for hundreds of dollars of ambulance costs.

    I don’t know of any studies, but I think there are people who will think twice about calling if Hatzala bills.

    This is one of the reasons this is a bad idea.

    #1642180

    ubiquitin
    Participant

    NC

    “This is money they need for operations, not profit”

    Is it though?

    “Before you try to somehow spin…”
    there is no need to spin and no need to pt words in my mouth. I am here and if clarification is needed I’m happy once again to elaborate

    “” There’s no way that quote is not assuming they are after profit. ”

    I am not assuming that. I think they see it as easy money that is just sitting there, and what is the harm in taking it. I (and some in Hatzalah brass) feel that there is a downside, not that their goal now is to make a profit, but that once they do there will be no turning back. Unless of course this replaces donors.

    “They are remaining non-profit. End of story.”

    Depending what you mean by “non-profit” I’m not sure why you are so sure. wil lthere not be a salary for the big-wigs? how do you know? How could you be so sure? to close with such a finality “End of Story”?

    “that’s just you being wrong.”
    Again, I am 100% ok with being wrong about this. Many, including many Hatzolah brass, think I am wrong ,or that the benefit outweighs the negative, and again I am not so sure it doesnt either.

    I jut am not sure how you are so sure that this definitely won’t change
    “maybe you should publicly advocate that people donate less to Hatzolah. Wouldn’t want them to become corrupt, right?”

    I don’t follow, if Hatzaola was raising more money than they needed, of course people should donate less (and give to a needy organization) is that a controversial opinion?

    #1642181

    ubiquitin
    Participant

    2scents

    “I am under the assumption that these monies will cover their operating budget ”

    Great! then I don’t see a problem. I just don’t want to risk changing an organization by hanging on an assumption

    #1642222

    Joseph
    Participant

    Is this change towards billing insurance being only done by Queens Hatzalah or is this now being changed by Central Hatzalah, affecting Brooklyn and Manhattan too?

    #1642227

    2scents
    Participant

    Ubiquitin,

    No one wants any change in Hatzolahs care, it seems we are all in agreement to this.

    Now if the concerns you listed are the same ones the opposing side has, it seems that this can be worked out so that all of these concerns are handled.
    Once those concerns are handled it would seem that you would also be in favor of billing.

    Or is it your opinion that the concerns raised cannot be handled and the people in charge are not capable of handling them?

    #1642288

    Amil Zola
    Participant

    I’m not too familiar with Hatzolah. It appears that there are a massive number of volunteers across the tri state area. Who pays for their EMT training? I know in some smaller towns in my area, members are reimbursed back for the cost of their EMT training after 5 years of voluntary service (fixed number of hours over a 5 year period). Other areas do not reimburse.

    #1642321

    Formerla
    Participant

    I think billing will inhibit people from calling. Especially if hatzolah sends them a bill and they haven’t reached their deductible. If they are only “soft billing” then based on the fact that most people will not have reached their deductible hatzolah will not be making as much as they may think. That couples with the fact that billing insurance has costs and that findings will go down may make it not worth dealing with the hassle.

    #1642330

    ubiquitin
    Participant

    “Now if the concerns you listed are the same ones the opposing side has,”

    It’s one of them

    “it seems that this can be worked out so that all of these concerns are handled”
    I’m not sure how, though again that is what the other side says. This is part of the argument

    “it would seem that you would also be in favor of billing.”
    This is but one concern, though again Like I said in most of my posts in this thread I’m not opposed to billing per se, I’m just answering the op’s question as to why some are (I do see how my last comment to you doesn’t quite sound that way, but in most of my comments I was careful to phrase it that I was not saying I was completely opposed now)

    #1642427

    Joseph
    Participant

    Perhaps in the future they’ll have paid Hatzalah members (either in addition to or instead of volunteer members) who respond to calls.

    Especially for the call that they currently don’t have any Hatzalah members willing or able to respond to.

    #1642650

    Neville ChaimBerlin
    Participant

    A copay and/or deductible would definitely deter people. Even if hatzolah offered to reimburse you for it, the shame of having to ask them like that could also be a deterrent. The only way to avoid that would be if hatzalah could pay it without the patient ever even seeing it. I’m not sure that’s possible.

    #1642658

    DaasYochid ☕
    Participant

    NCB, are you now seeing things differently than when you said you haven’t seen a rational reason not to bill insurance?

    #1642666

    Formerla
    Participant

    Hatzalah paying back deductibles would negate the whole purpose of billing insurance. Especially in today’s time of high deductibles. I really feel that the benefits don’t outweigh the negatives. Plus donations would definitely take a hit based on this model. I also agree aside from financial considerations biking would cause people to hesitate before calling which may weed out some abuse of the system, but may also cause some serious calls not to be made resulting in bad medical outcomes or C”V deaths.

    #1642674

    DaasYochid ☕
    Participant

    Hatzalah paying back deductibles would negate the whole purpose of billing insurance. Especially in today’s time of high deductibles.

    They would still get whatever amount the insurance company pays.

    It’s possibly insurance fraud, though.

    #1642673

    2scents
    Participant

    While the arguments against billing seem serious, its bassed on an assumption of the facts.

    A lot of hypothetical stuff. Do the areas that already bill including Catskill send bills to the patients?

    #1642682

    DaasYochid ☕
    Participant

    Do the areas that already bill including Catskill send bills to the patients?

    I’ve asked that twice…

    Two comments on the news story linked in the OP seemed to indicate that they got bills.

    #1642687

    DaasYochid ☕
    Participant
    #1642695

    2scents
    Participant

    DY,

    I tried looking for those comments yet was unable to find them, would you be able to post them here?

    It seems that one comment was on them seeing what their insurance company paid for the transport, not sure if that was the comment you are referring to.

    If in fact, it is as bad as some make it sound, how is it that Catskills Hatzolah and other areas that have been billing insurance for many years get away with all of these claims?

    #1642696

    Meno
    Participant

    The only way to avoid that would be if hatzalah could pay it without the patient ever even seeing it. I’m not sure that’s possible.

    Not really sure what this means. Co-pays and deductibles go straight to the provider (Hatzolah in this case), not the insurance company.

    #1642706

    Joseph
    Participant

    Insurance contracts and federal Medicare regulations prohibit a provider from forgiving (or paying themselves for the patient) the copay or deductible.

    #1642737

    ubiquitin
    Participant

    NC
    “The only way to avoid that would be if hatzalah could pay it without the patient ever even seeing it. I’m not sure that’s possible.”

    I second DY’s question “NCB, are you now seeing things differently than when you said you haven’t seen a rational reason not to bill insurance?”

    And I should note I raised this concern in the very first post on this thread (after the OP)

    The point of a deductible/copay is PRECISELY to deter patients from going to the doctor. A person won’t go to his/her doctor for sniffles if he knows it will cost him $20. OF course if its been going long enough, at some point it is worth the $20 and he’ll go. (Anecdotally, I have seen those whith medicare which often doesnt have a copay do have a lower threshold to seek medical care, I am not aware of any hard data on this, and this may not be a bad thing per se) .
    I don’t know about ambulance billing, but I do know about office billing and Joseph is exactly right “Insurance contracts and federal Medicare regulations prohibit a provider from forgiving (or paying themselves for the patient) the copay or deductible.””
    That isn’t to say copays arent waived for family/friends/professional courtesy/ financial need/ etc but these cases are TECHNICALLY insurance fraud (I’m anonymous here, right?) and obviously if done often enough and publicly at some point it would invite an audit.

    #1642734

    puttinginmy2cents
    Participant

    As I’ve said previously, from my own experience and knowledge, insurance companies do NOT bill patients for their co-pay. The provider (doctor, hospital, ambulance company) bills the patient for the co-pay that the insurance company doesn’t pay. I have never received a bill from Hatzoloh for my co-pay, and neither have any of my relatives. We know that the insurance companies did pay Hatzoloh, because it was listed on our monthly Explanation of Benefits. I would like to hear from anyone who has received a bill from any division of Hatzoloh.

    #1643539

    Formerla
    Participant

    Daas Torah
    “They would still get whatever amount the insurance company pays.
    It’s possibly insurance fraud, though.”
    If a person hasn’t reached their deductible then insurance will pay nothing. Most people who are relatively healthy don’t reach their deductible.

    #1643549

    DaasYochid ☕
    Participant

    Daas Torah

    Halevai…

    If a person hasn’t reached their deductible then insurance will pay nothing. Most people who are relatively healthy don’t reach their deductible.

    Then Hatzala won’t collect from them.

    #1643586

    Formerla
    Participant

    If Hatzolah doesn’t collect from them then they will not gain much by billing insurance and they will chase away donors by billing in the first place that is exactly my point they are not gaining much and maybe even losing by billing insurance. This is only the financial negative of billing there is also the danger of people not calling thereby hurting the mission of Hatzolah in the first place.

    #1643594

    DaasYochid ☕
    Participant

    If Hatzolah doesn’t collect from them then they will not gain much by billing insurance and they will chase away donors by billing in the first place that is exactly my point they are not gaining much and maybe even losing by billing insurance.

    I’ll let them figure out the finances. I’m sure this isn’t the reason Mr. Rowe resigned.

    Also, you’re not factoring in Medicaid.

    This is only the financial negative of billing there is also the danger of people not calling thereby hurting the mission of Hatzolah in the first place.

    I agree with you on that.

    #1643614

    Joseph
    Participant

    There seems to be a claim made here in the thread that in those areas where the local Hatzalah has already been billing insurance, Hatzalah has somehow been able to not bill the patient for the copay and/or deductible. This point needs to be clarified since this appears to be a contradiction to insurance contracts/regulations.

    As far as the idea that in many cases Hatzalah won’t be able to collect insurance payments due to high deductibles on some patients plans or due to the need for a lot of paperwork for file insurance claims or due to the high cost of running a billing operation to deal with insurance, all these are effectively immaterial to the large amounts of insurance they will be successful in collecting, even if a certain percentage of claims are ultimately denied.

    #1643616

    apushatayid
    Participant

    I’m not following. In the case of a TRUE emergency, Chas vshalom, someone would refrain from calling for help because of a copay or deductible? I’m trying to picture situation where Chas vshalom, someone’s having a heart attack lo aleinu, and in response to “someone call hatzalah” the person gasps, “no, i didn’t meet my deductible”.

    #1643618

    apushatayid
    Participant

    “Once they start making money the motivation will change ”

    I’m wondering why this is,seen as a for profit endeavor? Perhaps it a way to break even? Perhaps they don’t generate the donation$ we think they do.

    I have NO idea either way. I assume Mr. Rowe has an understanding of Queens Hatzalahs operations and finances that none of us have and more importantly, reportedly was given a psak what to do.

    #1643644

    🍫Syag Lchochma
    Participant

    Apy- I’m not following. In the case of a TRUE emergency, Chas vshalom, someone would refrain from calling for help because of a copay or deductible? I’m trying to picture situation where Chas vshalom, someone’s having a heart attack lo aleinu, and in response to “someone call hatzalah” the person gasps, “no, i didn’t meet my deductible”.

    You are exactly right, in a TRUE emergency they wouldn’t. But I don’t think people discussing the theoretical side of this are able to discern the difference between an emergency, and an event warranting a call to hatzola.

    #1643656

    Mammele
    Participant

    In other words, the guy’s not sure if he’s having a heart attack or it’s simply heart-burn… and he can wait for Tums to kick in.
    (I never quite understood how people confuse the two, but apparently they do.)

    #1643657

    apushatayid
    Participant

    @Syag. I’m not in the habit of assuming what others mean, so, to make sure I understand you. You are either saying, if Hatzalah will bill insurance, giving calle$ $kin in the game, so to speak, then they would only call in a true emergency, something hatzalah would like to see happen and is using this as a subtle way to ensure that happens. In which case you are ok if they implement this change. Or, you are saying, it will have a negtive effect because even in a true emergency, people MAY not call. In which case you are against. Or, I completely misunderstand what you wrote. Please clarify?

    #1643669

    🍫Syag Lchochma
    Participant

    Apy- I thought I heard you say that you can’t imagine someone having a true emergency and being hesitant to call hatzolo and I was agreeing with you 100%. I added that there are people who will argue that point, but I personally believe they are not able to differentiate between emergencies (which people won’t hesitate calling for despite fees) and things people consider true emergencies but aren’t actually so, in which case they MIGHT hem and haw.

    I absolutely do not think hatzolo has any bad intent nor would they try to reduce calls through this means. I just don’t think there are any scenarios of a true emergency where someone would hesitate.

    Regarding my vote, I hadn’t cast one.

    #1643888

    Neville ChaimBerlin
    Participant

    “NCB, are you now seeing things differently than when you said you haven’t seen a rational reason not to bill insurance?”

    Not really. The original comment I made was referring to the emotional arguments that were assuming this was for profit, which everyone seems to have decided not to go with. The conversation has now turned to copays/deductables. One person has said that the customer doesn’t get the bill in the towns that have implemented this.

    As far as hatzoleh helping the person pay the bill, I don’t see why that would be insurance fraud. I don’t think the insurance cares where you got the money to pay them. As for high deductables, if the deductable exceeds the cost, then it would pretty much be like dealing with someone without insurance, or like dealing in a system where you don’t bill insurance. It definitely wouldn’t put them on worse footing than now.

    #1643918

    bk613
    Participant

    People are definitely less likely to seek medical care if they have to meet a deductible or pay a co-pay. I have seen it time and time again in many different scenarios. There are both pros and cons to this. The pros are that people are less likely to come in and waste ems or doctors time with “silly” complaints. The cons are that people will decide their serious complaint is silly (chest pain is heart burn) and not seek attention.
    In my experience the latter rarely happens, but still can’t be discounted.

    #1643930

    Formerla
    Participant

    I am saying that I have encountered people who don’t want to go to the emergency room because they don’t have insurance or haven’t met their deductible. I am not saying this should necessarily be a consideration, just that it happens. If hatzolah bills those people will be less likely to call. Sometimes their not calling will lead to bad medical outcomes. The example you have is am extreme one but a subtle chest pain can be a heart attack. Hatzolah is built on the premise that even if one life is games it is with it too have the whole organization. If when one yiddeshe neshama is lost it is not worth implementing a something that will cause it.

    #1643956

    ubiquitin
    Participant

    NCB

    “Not really. The original comment I made was referring…”

    So one of several reasons wasnt rational not all of them.
    You still seem to be unsure about, the copay issue “I don’t see why…”

    You are probably right. There certainly is some way to set up a fund to reimburse deductibles without technically being insurance fraud. A simpler way is to send a bill but not collect (though i’m not sure if the bill is paid if they can refuse payment). This is an issue, that must be considered.
    There are other issues as well. IF you think this is a bigger issue, or even the only one fine. But to say there is no room for any discussion and no “rational reason” to oppose it is a bit short sighted.

    #1643957

    2scents
    Participant

    So far, from what I have heard I do not think that people actually receive bills for Hatzolahs services or even for copays.

    They do receive an EOB (explanation of benefits) from the insurance company, that lists how much the insurance company will pay and what is the patient’s responsibility.

    Yet, from what I have heard, no one receives any bill for anything from Hatzolah or from the billing companies they are contracted.

    Also, from the patients perspective, nothing has changed, members are still volunteers, they are not required to collect insurance or payment information, just as until now the members managing the call are the ones deciding on treatment or transport decision.

    This is why Hatzolahs have rabbonim that give guidance to avoid decisions that are not in the favor of the patient.

    #1643965

    Joseph
    Participant

    “As far as hatzoleh helping the person pay the bill, I don’t see why that would be insurance fraud. I don’t think the insurance cares where you got the money to pay them.”

    NCB: The primary reason insurance carriers create a copay or deductible is specifically to discourage unnecessary over-utilization of medical services. If medical providers waived/forgave copays/deductibles, patients would use the medical providers more frequently, costing the insurance carriers more. As such, virtually all the insurance carriers contracts with providers specifically prohibit them from waiving/forgiving payment of copays or deductibles and require they make a serious attempt to collect those fees. And they carry severe penalties for providers who violate this provision.

    #1644029

    apushatayid
    Participant

    i’m wondering if this entire discussion is limited to very specific situations. at times hatzalah does not have available resources to transport someone (especially to the hospitasl of their choice) and they bring in one of the private for profit companies to pick up the slack (it happens daily). the for profit company is entitled to make money and if they dont bill the patient, they can bill hatzalah, or, they can write it off as a donation to hatzalah. if they dont, this is an additional expense incurred by hatzalah.

    #1644025

    2scents
    Participant

    “But to say there is no room for any discussion and no “rational reason” to oppose it is a bit short sighted.”

    I do not think that anyone really thinks there aren’t any valid opposing arguments, there for sure are issues that they need to overcome.

    Now that they have decided to go the billing route, and technically have been doing so in the Catskills for a while, I do hope that they actually have a legitimate plan for those technicalities.

    #1644043

    2scents
    Participant

    apy,

    It seems that this is for all their transports, this will significantly reduce their need to rely on fundraising, it also seems that other areas including Catskills Hatzolah have been doing this for a longer period of time, for all their transports.

    Not sure if this played a factor, but from what I heard Hatolahs communication system is very outdated and an upgrade would be more than 20 million dollars, this is just one item on the list that is a direct result of being limited to fundraising for their expenses.

    #1644411

    Takes2-2tango
    Participant

    Does anyone know whether its legal for hatzoloh to not hire men who are not married?

    #1644549

    DaasYochid ☕
    Participant

    Does anyone know whether its legal for hatzoloh to not hire men who are not married?

    Does anyone know if this comment is relevant to the discussion?

    #1644554

    DaasYochid ☕
    Participant

    DY,

    I tried looking for those comments yet was unable to find them, would you be able to post them here?

    It seems that one comment was on them seeing what their insurance company paid for the transport, not sure if that was the comment you are referring to.

    Sure, FWIW.

    1)
    emesvyatziv
    December 6, 2018 7:32 pm at 7:32 pm
    As one who lives in Lakewood and received a bill from MONOC for the paramedics Hatzoloh sent the same day a Shnorrer letter was received from Hatzoloh, there is something very wrong. There are people making money off the system and that is wrong. Either it is a volunteer service deserving of our support or they should not do any fundraising.

    Rabbi Kalman Epstein is 1000% correct. This is not the right direction for this premier organization.

    2)

    Yyser
    December 6, 2018 8:33 pm at 8:33 pm
    Omg. I got a bill a few weeks ago in flatbush. They took my father in for chest pains. My insurance company paid them. Didnt cost me a nickel. But why do i need to donate a penny to hatzolah now?

    #1644574

    Takes2-2tango
    Participant

    20 million dollars for a phone upgrade?
    Sounds shady to be honest.
    Sounds alot like when a township pays a half million to put up a new light at an intersection.
    Im sure if hatzoloh had an open bit for a new phone system upgrade it would be less then half that figure.

    #1644595

    DaasYochid ☕
    Participant

    Does anyone know whether its legal for hatzoloh to not hire men who are not married?

    Perhaps you meant to ask whether billing insurance and Medicaid affects the legality of their “hiring” policies?

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