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Hilltown Archives — The Altamont Enterprise, February 19, 2009

Westerlo Rescue Squad may start billing transport patients

By Zach Simeone

WESTERLO — A divided town board and a divided volunteer rescue squad are looking at starting a revenue recovery process that would mean fewer tax dollars being budgeted towards ambulance services.

It was close to 10 years ago when the Westerlo Rescue Squad became its own, private entity. When it broke away from the Westerlo Volunteer Fire Company in 1999, it took $8,000 of that year’s budget with it. Since then, the rescue squad’s budget has reached $92,500 for 2009.

At its Feb. 4 meeting, the town board supported the rescue squad in looking at the advantages of a soft billing process, which would charge a patient’s insurance company, should the patient have insurance, when he or she is transported by the rescue squad. The goal is to save some, if not all, of the money now coming from taxpayers; the more revenue generated by soft billing, the less money would have to come from the town budget.

The choice ultimately remains in the hands of the squad, as it is a private company that has been incorporated since December of 1998, and a billing agency since January of 1999.

“We really don’t have to tell [the town board] anything,” Debbie Theiss-Mackey, who is on the squad’s board of directors, told The Enterprise this week. “Ten years ago, they implied that it was illegal, and said that we couldn’t bill, and now they want to see our numbers, as if we need their permission,” Theiss-Mackey said.

“Yes, of course we’re going to give [the town board] a general idea, but, in reality, we’re not going to have a clue how it will go — there is no way to tell,” she said. “We don’t know how many people in Westerlo have insurance. The way the economy is, more people are losing their jobs and their insurance every day. And, if they don’t have any insurance, then we might not get any money from them. I’m certainly not going around door to door and seeing how many people have insurance.”

When a rescue squad is part of a fire company, Westerlo Attorney Aline Galgay told The Enterprise, it is not permitted to bill its patients separately. “When the rescue squad first split from the fire department, it was in January, after the budget was done for that year.”

The rescue squad was to receive $8,000 that year from the amount that had been budgeted for the combined services with the fire department.

“Initially, the rescue squad had said they didn’t want to bill,” she said, “but, as their budget has gone up, they’ve been approached with the idea that it would lower the tax burden if they started billing.”

The discussion was brought on by a letter from newly elected Councilman Jack Milner to his fellow board members, also printed as a letter to the editor in The Enterprise, in which he said that at a future meeting, he wished to see, “a review of the issue of acceptance of payments from insurance companies by the Westerlo Rescue Squad. According to recent experience, accepting such payments could bring in nearly $100,000 per year.”

The other four town board members are not so sure, but showed support of the rescue squad’s considering the advantages of soft billing.

Milner’s $100,000 estimate was based on the squad’s current $92,500 budget, and conversations with Theiss-Mackey, who is the assistant captain, secretary, treasurer, and training officer in addition to being on the squad’s board of directors.

Ten years back

Theiss-Mackey says she’s an old-timer. When the squad split from the fire company, “I was the least in favor of billing,” she said, “only because I’m from the old school — you volunteer, there’s no money, and if someone wants to donate, that’s great.”

But, Theiss-Mackey said, she sees the advantages of revenue recovery, and likes the idea of lessening the drain on taxpayers. When the rescue squad initially became separate, it started billing out of necessity, since it was ineligible for town funds at that time, she said.

In 1998, “We got all our ducks in a line to be incorporated, but, because it was past the deadline to submit our own budget to the town that year, we couldn’t budget for the first year we were a rescue squad,” Theiss-Mackey said. “The first patient to get a bill was a lady in Greenville, who ended up calling the town about it. The town then processed it through the attorney, and [Galgay] said at that time that it was illegal for us to bill,” she said.

Asked why she told the rescue squad this, Galgay said, “The rescue squad had formed a corporation, but just forming a corporation didn’t make them a separate entity. At that time, the billing was not permissible, because the break from the fire company was not completed,” she said. “I never said that it would not be legal in the future.”

The $8,000 of funding that came from taxpayers in 1999 has become $92,500 in 2009. The budgeted amounts for the years between, according to Theiss-Mackey, were as follows:

— $30,000 in 2000;

— $36,380 in 2001;

— $47,626 in 2002;

— $54,850 in 2003;

— $55,500 in 2004;

— $60,500 in 2005;

— $76,000 in 2006;

— $86,600 in 2007; and

— $88,000 in 2008.

Neighboring services

In the other neighboring Hilltowns, volunteer ambulance companies get nearly half of their revenue from billing insurance companies.

Rensselaerville has budgeted $41,000 to its ambulance service this year. Brenda Wood, treasurer of Rensselaerville Volunteer Ambulance, estimates that the ambulance service has received an average of between $45,000 and $50,000 in gross revenue from billing in recent years, but was unsure.

“I don’t have the numbers for what they bill out,” Wood said. “There are people who aren’t insured, and, from people like that, we collect nothing. Every [insurance] company charges a different percent. And part is based on mileage, so, the closer they are the to the hospital, the less they’re going to get billed.”

As far as revenue expected for this year, the Rensselaerville squad has made no official projection, “because it’s all based on call volume, and call volume has gone up,” Wood said. “It used to be somewhere over 100 calls [per year]; total call volume is now usually over 200 [per year], although we don’t necessarily transport 200,” she said.

Helderberg Ambulance, which provides services to Berne and Knox, received $55,000 from this year’s Berne budget, and $25,500 from Knox’s budget. “And that’s based on call volume,” said Alan Zuk, President of Helderberg Ambulance. “What we receive [in billing] is roughly equal to the net amount we get from tax money.”


One concern with the rescue squad’s funding coming from the town budget, Theiss-Mackey said, pertains to mutual aid, which involves one town receiving ambulance services from another.

“If other agencies come into Westerlo for mutual aid and pick up a patient, and they’re a billing agency, they must bill everyone they transport,” she said. “But, if Westerlo goes into these other towns to [give] mutual aid for them,” and the Westerlo Rescue Squad does not have a soft-billing policy, “even if we’re in billing agency areas, we can’t bill them, so Westerlo’s people are paying for out-of-town services from the town budget.”

Asked if the Westerlo Rescue Squad would consider a policy that would involve billing only out-of-town patients for mutual-aid services, Theiss-Mackey said, “Law says that, if you’re a billing agency, you must bill everyone.”

The rescue squad, Galgay said, should exercise caution while considering soft billing.

“If you were a councilman, and the rescue squad came up to you and said, ‘We can make $100,000 a year,’ you’d say, ‘Well, then you don’t need to be in our budget,’” Galgay said. “So, if you have a [$92,500] budget, you better know exactly how much you’re going to receive by billing, because that’s how much the budget is going to be reduced by. It would be the prudent responsibility of the board to reduce the budget by what they can collect by billing. The purpose of billing, as stated at a meeting, is to reduce taxpayer burden,” she said.

But the rescue squad has no way of knowing whether the number of patient transports will increase or decrease, Theiss-Mackey said, and there are no projections yet of how much money might be made this year by billing.

“I suppose we could look back at 10 years’ worth of calls and predict, but we could always be wrong,” she said. “We had 351 actual EMS tone-outs,” meaning there were 351 different 911 calls made to reach the Westerlo Rescue Squad for emergency medical services last year, “but it doesn’t necessarily mean we went anywhere or did anything. Out of those, there were about 273 patients, but not all of them were transports. I think, on average, two-thirds of calls are usually transports. Unless we actually transport someone, we can’t bill them.”

When it comes to the source of its funding, Galgay said that the rescue squad will have a tough choice to make. “You’re not going to be able to bill and get the same budget — it’s one or the other,” she said.

While the Westerlo Rescue Squad is a billing agency, “it doesn’t mean you can’t call when you don’t have money,” Theiss-Mackey concluded. “With soft billing, if you don’t have insurance, you don’t get billed. We don’t want people to sit there and get sicker because money is the first thing on their minds.”

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