Billing FAQ

What are ‘Emergency Medical Services’? Daily, the citizens and visitors of Englishtown and Manalapan depend on our Emergency Medical Technicians to reduce the number of disabilities and deaths that occur from serious injury or illness by delivering high quality pre-hospital care to people in need. In 2017, EMS responded to approximately 3,800 calls for service with over 2,100 of those calls resulting in transportation to local medical facilities for emergency and trauma care.

Englishtown-Manalapan operates under a two-tiered EMS response system. Basic life support is provided by a partnership between the Englishtown-Manalapan First Aid Squad (EMFAS) providing volunteer EMT’s, and Western Monmouth Emergency Medical Services (WMEMS) supplementing the effort with career staff whenever volunteers are not available. Together we provide a seamless 24/7 operation, with no difference in service between career and volunteer. The second tier, advanced life support services, are rendered by MONOC on a primary basis, when MONOC is not available RobertWood Johnson Heathcare System or Capital Health provides back up.

Basic life support (BLS) is a level of medical care that consists of life saving procedures that are non-invasive and include activities such as control of bleeding, care of sprains, strains, and fractures, artificial ventilation, cardiopulmonary resuscitation (CPR), and delivery of oxygen. BLS care is delivered by trained emergency medical technician (EMT) providers. Advanced life support (ALS) is a higher level of medical care as compared to BLS. ALS care includes the performance of non-invasive and invasive procedures such as cardiac monitoring and defibrillation, establishment of intravenous (IV) lines, delivery of medications, and placement of advanced airways. Specially trained paramedic providers deliver ALS care.

What is our billing program? The billing program is a cost recovery initiative for emergency medical services (EMS) where we bill insurance providers for our services to help as a “cost-recovery” program and a mechanism to help offset the costs of providing emergency medical services. The revenues generated by this billing program will not compensate WMEMS/EMFAS for the total cost of providing emergency medical services; however, we continue to depend on the generous contributions by our residents.

Why begin the billing program now? Englishtown and Manalapan have grown tremendously over the past few decades and that growth has placed service delivery demands on our system. The new economic reality that Englishtown-Manalapan, our region, state, and the entire nation now find themselves in requires us to evaluate every possible option for generating revenue, while considering the amount of tax burden we place on our citizens. Most surrounding municipalities already have an EMS billing program in place. If those surrounding jurisdictions are required to respond to assist WMEMS/EMFAS and provide an EMS transport, they charge our residents for their services. Additionally, residents using the services of commercial ambulance providers also receive a bill for services. Health insurance costs, including EMS transport services, are included in insurance premium actuarial calculations. Not billing for services for which premiums have already been paid benefits only the insurance companies. This situation results in WMEMS/EMFAS irretrievably losing legitimate revenue, which in turn could be used to assist in addressing the many operational needs.

How will this billing program impact service? This program will not impact the service that you receive from WMEMS/EMFAS. Emergency medical care and transport of our citizens remains our top priority and EMS will always be provided without regard to anyone’s ability to pay.

How will my insurance company be billed? We will bill the appropriate insurance providers for transported patients by using a separate third party billing company to perform the specialized service of insurance billing. Your insurance company will pay the bill in the same manner other medical bills are paid.

What about Advanced Life Support service fees? When medical conditions warrant, an advanced life support service will be dispatched in conjunction with WMEMS/EMFAS. In those cases, you will receive a separate bill from MONOC. WMEMS/EMFAS will never bill for ALS services. Currently MONOC (Monmouth Ocean Hospital Service Corporation) REFUSES to enter into a bundled billing agreement with WMEMS. We do have a bundled billing agreement with RobertWood Johnson Healthcare and Capital Health. The bundled billing agreement allows the ALS provider to bill Medicare/Medicaid on our behalf and share the revenue provided. MONOC refuses to share any of the revenue provided by Medicare/Medicaid, instead they favor billing our residents directly for their full cost and blame our organization for not entering into an agreement with them. {Below we have provided you with the discussions between WMEMS and MONOC.}

What if my insurance company won’t pay? The billing approach WMEMS/EMFAS will use is described as a “compassionate” approach, meaning that the direct financial impact to township residents will be minimized as much as legally possible. Manalapan Township and Englishtown Borough still provide financial support to our organization. That support is derived from tax revenues which cover balances not paid by the residents' health insurance (such as an insurance co-payment or deductible).

What if I have Medicare? Medicare will pay 80 percent of the allowable charge for medically necessary EMS transports. Supplemental insurance, if any, may cover all or part of the balance. For Englishtown and Manalapan Township residents, any remaining co-payment or deductible will be covered by their tax revenues.

What if I don’t have insurance? If a township resident is transported and does not have health insurance coverage, our organization does not seek payment from our residents to cover the financial obligation for their EMS transportation. We will develop a waiver policy to address situations where there may be an inability to pay or involve other special circumstances.

Will I have to show proof of insurance before I am transported to the hospital? No. Emergency medical services and transport will be provided in the same way it has always been. The only change you will see is we will now be asking for your insurance information and/or your Social Security number. Billing activities will be performed after any medical treatment has been provided. Additionally, we will pursue an electronic data interface with our receiving hospitals to provide patient insurance and demographic information necessary for EMS billing.

How will my privacy be protected? The Health Insurance Portability and Accountability Act (HIPAA) ensures patient information is protected. WMEMS/EMFAS is a covered entity under HIPAA’s privacy and security regulations and will continue to adhere to these standards.

Who will I call if I have a billing question or problem related to this program? Ambulance Billing Company, 908-479-4921, will be your point of contact to address any billing related questions. The contact numbers are included in all billing statements.

WMEMS Monoc.pdf
WMEMS Monoc 052015.pdf