Insurance Reimbursement

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Do you have questions about Lyme Ambulance’s plan to request reimbursement from insurance companies?

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Lyme Ambulance will be pursuing “reimbursement for services”.  What does that mean? 

Since our founding in 1974, Lyme Ambulance has provided emergency medical services to the town of Lyme at no cost to our patients or the Town.  Starting in the Spring of 2022, our patients’ health insurance providers will be billed whenever we transport to an emergency facility. The State of Connecticut sets the billing rates, and most patients’ health insurance will cover most, if not all, of the cost. 

When will the new policy take effect, and how will it impact the  first responders’ duties? 

Billing will start in Spring 2022.  We received approval from the State of Connecticut in mid-February and are processing the documents necessary for implementation. The only impact it has on first responders is administrative. They will now obtain a signature from our patient and the emergency facility at the end of each transport as evidence to the insurance provider that we performed the transport and turned the patient over to a competent medical service provider. 

Why is Lyme Ambulance changing its policy if it has worked well for over 40 years?

There are several reasons, but the most important is that the cost of providing high-quality emergency medical care has escalated well above a point where we can expect to cover operating expenses and capital costs from donations alone. We simply need another source of revenue to sustain our commitment to the residents of Lyme. Reimbursement from insurance companies is the best option, and we are one of the very few ambulance services in the state that does not already accept reimbursement. Our residents have paid health insurance premiums for years; we think it is smart to ask the insurers to cover their customers’ ambulance costs like they do in the rest of Connecticut. 

Does Lyme Ambulance have financial problems? 

No. Lyme Ambulance’s financial position is very solid, and we want to keep it that way. Seeking reimbursement for services is prudent for a critical community service like Lyme Ambulance to reduce our dependence on donations. EMS is a costly function that requires major capital expenditures, and the additional revenue is a way to ensure that Lyme Ambulance maintains its strong financial position, enabling us to serve in the future. 

Will ‘reimbursement for services’ impact Lyme’s mill rate or real  estate taxes?  

No. Lyme Ambulance Association is a private, not-for-profit corporation licensed by the State to provide emergency medical services to the town of Lyme. The Town does not pay Lyme Ambulance any fees for its services, nor will they as a result of reimbursement for services.  

Will Lyme Ambulance continue to ask for donations from the  community?

Lyme Ambulance has been very fortunate with the generosity of our community over the years, and we have always been very grateful for their support. Lyme Ambulance is seeking reimbursement for services to supplement donations, not replace them. Both revenue sources are needed to stay ahead of escalating costs.  

Does Lyme Ambulance seeking “reimbursement for services” provide any benefits to Lyme residents? 

Yes, and a very significant one. Under our existing non-billing model, paramedic bills are not covered by insurance and are paid by the patient. Once Lyme Ambulance starts seeking reimbursement from insurance companies, the paramedic bill will be bundled with Lyme Ambulance’s bill and covered by public insurance providers. Between 30 and 40 calls a  year in Lyme involve paramedics, meaning Lyme residents will save between $25,000 and $35,000 a year in out-of-pocket paramedic costs. 

How much will it cost a resident if they call 911 and Lyme  Ambulance responds to the call? 

There is no cost if the resident is not transported. If they are transported, the resident’s health insurer will be billed directly by Lyme Ambulance’s third-party administrator (Shared Response), and the resident will be invoiced for whatever is not covered by their insurer as set forth below (2021 amounts):  

• Medicare with a supplement – all costs are covered*
• Medicare without a supplement – $81* 
• Medicaid – all costs are covered 
• Medicare Advantage – depends on the plan selected
• Private insurance – depends on the plan selected
• No insurance – amount allowed by the state (approximately $800, plus mileage) 
• There will not be any paramedic bills for patients covered by Medicare or Medicaid

* After an annual $211 medical deductible has been met. 

What if a resident is not in a financial position to pay for an  ambulance? 

Lyme Ambulance will embrace a compassionate collection policy, meaning our services will be provided to all Lyme residents regardless of their ability to pay. The decision on unpaid bill collection will be made by Lyme Ambulance, and we will accommodate any patient with a legitimate reason for not paying. 

Please note: Under Medicare regulations, Lyme Ambulance’s billing policy and amount (as set by the state) are required to be the same for all patients. Industry practice is for all patients to receive up to three bills before any other steps are taken, even if they are already in conversation with Lyme Ambulance or its administrator about their bill. 

Is this being done so that Lyme Ambulance volunteer first  responders can get paid a salary? 

Lyme Ambulance has been the only ambulance service in the region where volunteer first responders have not received compensation for being on duty. However, given the regional and national difficulties with EMS recruitment and retention, we now offer a modest stipend to Lyme Ambulance responders. That decision was made independently of the decision to seek insurance reimbursement, which is something we have been working on for more than two years.