Understanding TotalCareTotalCare provides for the prepayment of co-payments and deductibles for all medically necessary EMSA ambulance services for which the patient (or his or her insurance provider) has financial responsibility. Additionally, individuals receiving TotalCare benefits pay a reduced rate of 40% off the regular cost of non-emergency transports. The City of Tulsa's TotalCare 2008-2009 program provides benefits for participating utilities account holders and permanent residents of participating households from July 1, 2008-June 30, 2009. Who Is Covered? Paying the utilities bill fee provides benefits for the utilities account holder and all permanent members of the household. A person being cared for in a nursing home may be covered under a spouse's residential utilities account. Program Benefits. TotalCare benefits are applied to emergency and non-emergency ambulance transports provided by EMSA within the EMSA service area. Patient preference usually determines to which hospital the patient is transported; however, in cases of life endangerment, the closest appropriate hospital will be used. Emergency transports are fully covered. An emergency is defined as an unforeseen condition that requires urgent and unscheduled medical attention. Emergency transports always result in the ambulance taking the patient to a hospital emergency room. Non-emergency transports are fully covered if insurance or other third-party coverage provided benefits for the service (even if subject to deductible, co-payment or co-insurance). If no insurance or other third-party coverage is available or if the claim is denied, the recipient of benefits is charged a reduced fee (40% off EMSA's standard non-emergency rate). A non-emergency transport is a medical transfer that does not have a hospital emergency room as the final destination. Excluded Services. Beneficiaries must present a completed physician certification statement (PCS) to receive benefits for non-emergency transports. TotalCare provides no coverage for non-emergency transports without a PCS. The patient's physician usually completes certificates. Repetitive transports for services such as dialysis, radiation therapy and chemotherapy are not eligible for TotalCare benefits without additional screening and insurance approvals. TotalCare does not cover non-emergency transports to and from doctors' offices, dentists' offices, physical therapy centers, pharmacies, freestanding clinics and other facilities. Transports outside of EMSA's service area are also not included in the program. Members will receive a full bill for excluded services. Before requesting non-emergency service, please call 396-2888 to determine the transport's eligibility. Agreement. Participating utilities customers and/or their insurance providers are responsible for payment of ambulance services provided to them by EMSA. It is the responsibility of participating customers to provide EMSA with insurance and third-party payer information pertaining to them or anyone living in their household who receives EMSA services; failure to do so nullifies this agreement. In consideration for payment of the EMS assessment, participating customers hereby assign to EMSA all ambulance benefits that they or any covered family member may otherwise be entitled to receive from any insurance or other third-party payer for services provided under the TotalCare program. EMSA will accept this assignment as payment in full for emergency transports, and for non-emergency transports if insurance or other third-party payer coverage provides benefits for the transport. EMSA will file ambulance insurance claims for each covered person and is entitled to receive payment from all insurance or other third-party payers up to the amount of EMSA's usual charges. If no insurance or other third-party payer benefits are available or if the insurance company or other third-party payer denies payment for non-emergency service, participating customers will remain responsible for payment of a reduced fee of 40% off EMSA's standard non-emergency rate. Any insurance or other third-party payment participating customers receive related to EMSA's services provided under the TotalCare program should immediately be delivered to EMSA, if there is an outstanding balance on the customer's account. Learn More Now... City of Tulsa: Single-Family Residential Utilities Customers City of Tulsa: Multi-Family Residential Utilities Customerss |
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