Published in the August 5, 2015 edition
By MAUREEN DOHERTY
LYNNFIELD — The Board of Selectmen has authorized Action Ambulance to pursue unpaid portions of EMS bills from insurers going back six years.
Fire Chief Mark Tetreault explained that although insurance companies are billed for each ambulance transport made, they have engaged in a practice to pay only “a usual and customary amount” rather than the full bill.
Tetreault added the amount insurance companies have been willing to pay over the years was “somewhat arbitrary.” Other communities were facing the same difficulty, so the legislature passed a law prohibiting the practice, he said.
“The theory is it could bring a significant amount of money back to the town to help right the ship on the ambulance enterprise account,” the chief said at the July 13 meeting.
Selectmen Chairman Phil Crawford asked whether Action Ambulance would receive a percentage of the fee in return for this service. Tetreault said no because the town already pays them to provide billing services.
“They just need authorization from you to send out letters and the goal would not be to bill residents more money. It is for the insurance companies to pay what they should be paying,” the chief said.
Town Administrator Jim Boudreau said the outstanding money owed to the town from past EMS transports just from motor vehicle insurance companies, not health care companies, “would be about $36,000.”
Selectman Tom Terranova made a motion to allow Action Ambulance to conduct this billing service for the town.
Prior to the unanimous vote, Bourque Road resident Mark McDonough asked if this authorization would mean that the town would be doing “balance billing.”
“Balance billing is when an insurance company says this is how much we are going to pay you for a service and that’s it, like Medicare,” McDonough said.
Tetreault stressed that “we accept what Medicare pays. This is balance billing for insurance companies who arbitrarily set a figure” they’re willing to pay the town.
Using a $2,000 bill as an example, Boudreau said an insurance company may have only paid $1,750 to the town. “We’re going back after the $250,” he said.
McDonough was concerned that if the insurance company refused to pay that $250 balance the town would then bill the resident for the unpaid balance.
Boudreau assured him, “We will not be chasing down residents to pay that bill.” Tetreault explained that “deductibles have to be met” so it is possible insurance companies could seek those costs, “but that is no different from what we’ve been doing all along.”
McDonough said that would be “balance billing, which we shouldn’t be doing. I was a selectman when we set up the ambulance account.”
Boudreau reiterated, “We are not going to be chasing the residents; we’re going to be chasing the insurance companies…We made it perfectly clear to the billing company that we do not want any residents to be getting bills.”
Fiscal year-end transfers
Fiscal year-end transfers totaling $69,166.08 were approved by the selectmen from the town’s FY 2015 health insurance account to balance five other accounts.
This action is allowed by the selectmen under a 2006 state law, with the approval of the Finance Committee, as long as such transfers do not exceed, in aggregate “three percent of the annual budget of the department from or within which the transfer is made or $5,000, whichever is greater.”
The law also requires that such transfers be made only “within the last two months of any fiscal year or during the first 15 days of the new fiscal year to apply to the previous fiscal year.”
The annual health insurance budget is $2,564,000. Based on this formula, the funds transferred from this account cannot exceed $76,920. The health insurance account had a balance of $95,767.25 at the end of the 2015 fiscal year on June 30.
The accounts into which these funds were transferred and the amounts of those transfers were as follows: Town Administrator’s salaries ($4,800), Fire full time salaries ($22,238.30), Fire Alarm salaries ($1,232.46), Unemployment insurance ($19,218.71) and Medicare F.I.C.A. ($21,676.61).
Four out of these five accounts had a shortfall. The unemployment insurance fund had a balance of just over $8,700 when the fiscal year ended.
T.A. Boudreau pointed out that the funds transferred into the “Town Administrator’s salaries” budget are owed to retired T.A. Bill Gustus. “None of that $4,800 is going to me,” Boudreau said.
The next Board of Selectmen meeting will be held on Monday, Aug. 17 at 7 p.m. in their meeting room at Town Hall.
Due to the Labor Day holiday falling late this year, on Monday, Sept. 7, the board will meet on Wednesday, Sept. 9 at which the warrant for the October Town Meeting will be opened. The board will close the warrant on Thursday, Oct. 1.