Chairman of the Board of Selectmen Leo Blair is eager to clarify the selectmen’s policy on ambulance billing. In a recent interview with the Press, he expressed his concern that there appears to be significant misinformation circulating in town regarding the selectmen’s recent decision to begin billing for ambulance service.
Blair said that the selectmen are currently drafting a paper that clearly outlines the history and facts surrounding the issue and explains the reasons behind the selectmen’s decision. In short, Blair said, the selectmen’s position paper centers around the following points:
1. Ambulance billing is still free to residents of Harvard. Blair explained that under the new policy, the town will bill insurance providers for ambulance services rendered to their subscribers. However, only insurance providers and Medicare will be charged for these services. No recipient of the service, said Blair, will be billed for any charges whatsoever, including copays. Further, uninsured people will receive the service free of charge. Blair added that all payments received from the insurance providers will be deposited into a separate, segregated account that will be used exclusively for expenses associated with the ambulance service.
2. The town stands to profit significantly from billing. Blair was eager to respond to the argument that the administrative costs associated with ambulance billing would outweigh the benefits. He explained that the selectmen used numbers from fiscal year 2008 and reimbursement rates published by Medicare to estimate potential revenue from billing. According to town records, 221 people required transport to a medical facility. Of these, 110 calls required Basic Life Support (BLS) services at a rate of $370 per call, while 110 required Advanced Life Support (ALS) services at approximately $225 per call. He explained that the fees for the ALS calls were lower because they were shared with other respondents, since no one on the Harvard Ambulance Service is currently certified to provide ALS services. Based on these numbers, the selectmen calculated that the town could have received payments of $65,785, and they rounded the total down to $62,500 to account for uninsured people.
As for administrative costs associated with billing, Blair reported that municipal ambulance services typically contract with third-party billing companies, which charge between 3½ and 6 percent for overseeing administrative and collection activities. Blair added that there would be limited paperwork for ambulance volunteers to complete that could be “accomplished using existing staff with no incremental increase in cost.”
3. Funds that were donated to the Ambulance Service and that are currently held in private accounts must, by law, be turned over to the town—but they will be held in a separate “gift fund” that is dedicated exclusively to the Ambulance Service. The selectmen continue to be concerned about a Harvard Ambulance Service bank account that is being privately held. Blair explained that it is against Massachusetts law for any town funds to be held in a private bank account. Since it is the obligation of the Board of Selectmen to ensure that any privately held funds are transferred to Finance Director Lorraine Leonard, Blair said that “the Board of Selectmen is currently liable for criminal charges” until the funds are turned over.
As of this writing, one of the accounts with a current balance of approximately $6,000 has been turned over to Leonard. The other account has not yet been transferred.
Blair is aware of concern on the part of many residents that if the Ambulance Service were to turn over these funds, they would be put to general use instead of being dedicated solely to the Ambulance Service. At the Aug. 5 meeting of the Board of Selectmen, former Assistant Director of the Ambulance Service Charles Perry expressed this concern, noting of the funds that “they’re donated by citizens to us for the purposes of whatever we want to do with them.” Blair was eager to reassure residents that the funds will be held in a separate trust so they can be used exclusively by the Ambulance Service.
The bottom line, said Blair, is that the town is facing serious financial challenges, limited revenue streams, and a population that is clearly reluctant to support an override. He reported that the selectmen are taking very seriously the fiscal burden facing the town and are responding to a clear message from residents that it is time to explore other options for income. Blair pointed out that the estimated revenue from billing could more than cover the Ambulance Service’s annual expenses, and that while it is indeed a small amount relative to the entire town budget, it is significant.
Last week, residents unhappy with the selectmen’s decision on ambulance billing collected enough signatures to call for a Special Town Meeting to address the issue. As of this writing, the Special Town Meeting has not yet been scheduled, but according to state law it must take place within 45 days of submission of the petition. So by the end of October, the meeting will take place—and Harvard residents from both sides of the issue will have the opportunity to make their case to their fellow voters.
