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Town of Mashpee <br /> Board of Selectmen <br /> Policy No: 053 <br /> Ambulance Billing Policy <br /> The policy of the Board of Selectmen is to collect all receivables as generated by the Mashpee Fire Department <br /> ambulance with the exception of cases where payment would create a severe financial hardship. It is with this <br /> intent that the following policy guidelines are established. <br /> l. The town shall contract with a private billing company for billing services. The Billing Company will <br /> issue an invoice to the patient covering the cost of the ambulance transport. The reverse side of this <br /> invoice will ask for insurance information to be provided by the patient. The billing company will then <br /> bill the insurance company. If no insurance information is provided,the patient is responsible for <br /> payment of the bill. <br /> 2. If there is no response to the first bill, a second bill will be sent after 30 days with a heading marked <br /> "Account Past Due". A phone call will be made to the patient regarding the past due account by the <br /> billing company to determine the patient's ability to pay. <br /> 3. If there is no response to the second bill, a third bill will be sent with a heading marked"Account 60 <br /> Days Past Due". <br /> 4. If there is still no response,the fourth bill, sent after 90 days,will inform the patient that their account is <br /> "Seriously Past Due" and could be sent to a credit bureau/collection agency. At the 90 day past due <br /> period the Fire Chief shall review the status of the account with the Billing company to assure that the <br /> patient is taking action to pay the outstanding bill or request abatement. If no action has been taken the <br /> bill will be sent for review as listed in#6. <br /> 5. In cases of financial hardship, ambulance bills may be abated. In order to qualify for abatement,the <br /> following steps must be taken: <br /> A. If the individual has private health or accident insurance,Medical Assistance, Medicare, SSI, or <br /> general assistance, it must be applied for before being considered for abatement. <br /> B. If the patient has been approved for free care by a recognized health care facility'a copy of said <br /> approval shall be included with the request for the abatement. <br /> C. If there is no insurance or governmental assistance available and only the patient is responsible, <br /> a signed and dated statement must be forwarded to the Fire Chief stating,"I certify,under the <br /> pains and penalties of perjury,that I do not have the financial resources or insurance to cover <br /> this ambulance bill."The account will then be sent for review as listed in#6. <br /> 6. After an account is six months over due, determined to be inactive at the 90 day period, or abatement <br /> has been requested, a panel consisting of the Town Manager, the Fire Chief and the Fire Department <br /> Liaison from the Board of Selectman shall review the account. The panel will rule if the bill should be <br /> abated or forwarded to the Tax Collector or his/her assignee for collection. <br /> Adopted by the Mashpee <br /> Board of Selectmen <br /> June 18, 2007 <br />