Leader

 

The Taney County Ambulance District (TCAD) billing office is open from 8:00 a.m. to 4:30 p.m. Monday through Friday. 1-800-367-9111. This e-mail address is being protected from spambots. You need JavaScript enabled to view it

 

Taney County Ambulance District rates are set by our Board of Directors. Rates are determined based on the costs of operating the District.

We charge an applicable base rate and mileage for all transports. As a courtesy to our patients, we will submit a claim to your insurance if you provide your coverage information to us at the time of service or to our billing office immediately after receiving service. Patients who receive treatment and are transported by other means or refuse ambulance transport are assessed an applicable base rate or non transport service charge.

INSURANCE

Insurance companies have timely filing limits, which often vary from 30 days to 1 year. Meaning the claim must be filed sometimes as quickly as 30 days after the date of service to ensure claims payment from your insurance. Therefore timely billing is extremely important. TCAD will not be responsible for claims not filed within the timely filing period. The patient is responsible to follow up for payment with their insurance. If your insurance fails to pay your claim within the 45 day grace period, payment will become patient responsibility.

Insurance coverage varies widely from policy to policy. Please contact your insurance company if you have any questions about your policy or coverage. If your policy does not provide 100% coverage for ambulance transportation, you may be required to pay a deductible, co-payment or co-insurance. Payment of all deductibles, co-payments and co-insurance is due upon receipt of your invoice.

MEDICARE

Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant). Ambulance services are covered by Medicare Part B, unless you have elected Medicare Part C, which is a Medicare Advantage Plan that provides your Part A and Part B coverage but can charge different amounts for certain services.

Medicare will cover medically necessary ambulance transportation to the nearest appropriate facility. Medical necessity is established when the patient's condition is such that use of any other method of transportation is contraindicated. In any case in which some means of transportation other than an ambulance could be used without endangering the individual's health, whether or not such other transportation is actually available, no payment may be made for ambulance services. Because the Medicare ambulance benefit is a transport benefit, if no transport of a Medicare beneficiary occurs, then there is no Medicare covered service.

As a general rule, only local transportation by ambulance is covered, and therefore, only mileage to the nearest appropriate facility equipped to treat the patient is covered. The term "appropriate facilities" means that the institution is generally equipped to provide the needed hospital or skilled nursing care for the illness or injury involved. In the case of a hospital, it also means that a physician or a physician specialist is available to provide the necessary care required to treat the patient's condition. However, the fact that a particular physician does or does not have staff privileges in a hospital is not a consideration in determining whether the hospital has appropriate facilities. Thus, ambulance service to a more distant hospital solely to avail a patient of the service of a specific physician or physician specialist does not make the hospital in which the physician has staff privileges the nearest hospital with appropriate facilities. The fact that a more distant institution is better equipped, either qualitatively or quantitatively, to care for the patient does not warrant a finding that a closer institution does not have "appropriate facilities."

Medicare beneficiaries entitled to Hospital Insurance (Part A) who have terminal illnesses and a life expectancy of six months or less have the option of electing hospice benefits in lieu of standard Medicare coverage for treatment and management of their terminal condition. When hospice coverage is elected, the beneficiary waives all rights to Medicare Part B payments for services that are related to the treatment and management of the terminal illness during any period the beneficiary's hospice benefit election is in force, except for professional services of an "attending physician."

If you have filed an appeal with Medicare, please notify our office and we will hold your bill for 60 days to allow Medicare time to process your appeal. You have the right to appeal any decision about your Medicare services. This is true whether you are in Original Medicare or a Medicare managed care plan. If Medicare does not pay for an item or service you have been given, you can appeal. Your appeal rights are on the back of the Explanation of Medicare Benefits or Medicare Summary Notice that is mailed to you from a company that handles bills for Medicare. The notice will also tell you why your bill was not paid and what appeal steps you can take.

The phone number to contact Medicare directly is 1-800-MEDICARE or 1-800-633-4227. The Medicare and You handbook along with other valuable Medicare information for beneficiaries can be accessed at:

http://www.medicare.gov

In Missouri you can also contact CLAIM for assistance with your Medicare benefits. CLAIM is Missouri's State Health Insurance Assistance Program. CLAIM is nonprofit providing free, unbiased information about Medicare to Missourians. Their goal is to provide local counselors to help the Medicare beneficiary get the most from your Medicare benefits. The phone number to contact CLAIM is 1-800-390-3330. Their website address is:

http://www.missouriclaim.org

MEDICAID

Medicaid is a State program intended to assist medically indigent citizens. Medicaid programs are administered by each State. TCAD is only enrolled with Missouri Medicaid. We do not participate in out of State Medicaid programs. Therefore, we are unable to file claims for out of State Medicaid programs.

Missouri Statute 208.152 authorizes MO HealthNet coverage of emergency ambulance services. Ambulance services are covered if they are emergency services and transportation is made to the nearest appropriate hospital. Emergency services are services required when there is a sudden or unforeseen situation or occurrence or a sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) that the absence of immediate medical attention could reasonably be expected to result in:

1. Placing the patient's health in serious jeopardy; or

2. Serious impairment to bodily functions; or

3. Serious dysfunction of any bodily organ or part.

Non-emergency medical transportation (NEMT) is available to eligible MO HealthNet participants who do not have access to free appropriate transportation to and from scheduled MO HealthNet covered services. NEMT services are arranged through Mecical Transportation Management, Inc., the NEMT broker for MO HealthNet. To see if you are eligible for NEMT, call 1-866-269-5927. NEMT services are available 24 hours per day, 7 days per week, when medically necessary. To provide adequate time for NEMT services to be arranged, a participant should call at least three (3) days in advance.

When a participant elects MO HealthNet hospice services, the hospice provides or arranges for all care, supplies, equipment and medicines related to the terminal illness. MO HealthNet pays the hospice who then pays the provider. Ambulance services related to the terminal illness must be authorized or requested by the hospice provider and are reimbursed by the hospice provider.

The phone number for Medicaid participants to contact MO HealthNet is 1-800-392-2161. The Missouri HealthNet Participant Handbook and other valuable information can be obtained on their website at:

http://www.dss.mo.gov/mhd/participants/index.htm

PAYMENT & COLLECTION

We accept payments by private check and major credit cards, including; Visa, MasterCard, Discover and American Express. We understand that some patients have unique circumstances which require special assistance in order to settle the balance of their account. TCAD prefers to make these arrangements themselves as opposed to involving other parties. However if the bill reaches the end of the billing cycle with no response from the patient on the balance due, the bill will be sent to a collection agency. Our collection agency is NCO Financial Systems. They can be reached at 1-800-275-5196.