Medicare & Health Insurance Plan
Depending on a patient's health insurance coverage and benefits, an insurance provider may deny a claim or pay only a portion of the bill. A patient may have a high deductible or a plan requiring co-payments. If a patient has secondary or additional insurance, a claim may be filed with those providers as well but, ultimately, any unpaid balance is the responsibility of the patient. The LAFD does not contract with private insurance companies and City policy establishes full cost recovery associated with providing ambulance transportation to patients. The Explanation of Benefits (EOB) provided by an insurance company should explain what portion of the ambulance bill is the patient's responsibility.
Patients transported by LAFD ambulance are agreeing to allow the LAFD to bill their insurance provider(s) and collect payment from those insurance providers in-lieu of being billed directly and having to seek reimbursement from their provider. Patients will receive a bill if the LAFD is unable to collect payment from an insurance provider or if there is any unpaid balance.
3. If a patient has more than one insurance provider, will the LAFD bill the other insurance for the balance? Will LAFD re-bill insurance providers if they receive new information?
If a patient's account has a balance and they provide new or updated insurance, the LAFD will attempt to file a new claim. It should be noted that an insurance provider may deny a claim if it is not filed within a certain time frame. Filing deadlines vary by insurance carrier and the LAFD is not responsible for the failure of patients to provide valid insurance information in a timely manner.
4. What does it mean when Medicare denies a claim as "not medically necessary" or otherwise refuses to pay the bill? Is the patient responsible for payment?
5. What happens to the balance on an account if Medicare does not pay the full amount?
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