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1. If I participate, who is covered?

All permanent residents of your household are covered, regardless of their age or whether they are a blood relative of the utility account holder. The person just has to reside in your household. Someone simply in town visiting is not covered. A good test is to see whether the person receives bills and mail at your address. Please make sure all permanent residents in your home over the age of 18 are listed on your utility account.

2. I have insurance and/or Medicare. Why should I participate? Isn't it like I'm paying for the same thing twice?

If insurance / Medicare always paid 100% of ambulance claims, you'd be correct. But the reality is this: insurance and Medicare deny about 30% of all ambulance claims. If this happened to you and you weren't participating, then you would be personally responsible for paying EMSA's full-billed charge of $1,300 plus $12 per mile. Even when insurance / Medicare approve claims, many people still have a financial burden: a $50 to $250 deductible, a 20% copayment (like with Medicare), or the difference between the billed charge and how much insurance will cover. If you participate in the program, you have no out-of-pocket costs for EMSA emergency ambulance transports. Whatever insurance / Medicare pays is counted as payment in full.

3. What if my personal insurance and/or Medicare doesn't cover the full cost of the claim?

Even when insurance / Medicare approve claims, many people still have a financial burden: a $50 to $250 deductible, a 20% copayment (like with Medicare), or the difference between the billed charge and how much insurance will cover. If you participate in the program, you have no out-of-pocket costs for EMSA emergency ambulance transports. Whatever insurance / Medicare pays is counted as payment in full.

4. What constitutes an emergency transport?

An emergency transport occurs any time EMSA transports you to a hospital emergency room for urgent, unscheduled treatment of an unforeseen medical condition.

5. What constitutes a non-emergency transport?

A non-emergency transport is a medical transfer that does not have a hospital emergency room as the final destination. For example, EMSA often transports individuals to nursing homes just after hospital discharge.

6. Do participating customers receive benefits for non-emergency transports, too?

EMSA non-emergency transports are fully covered if your insurance or other third-party coverage provides benefits for the service. That is, EMSA will accept as payment-in-full whatever your insurer pays on the transport and you won't be subject to out-of-pocket costs. If you don't have insurance or your insurance won't pay for the non-emergency transport, you'll be charged a reduced fee, which is 40% off EMSA's standard non-emergency rate. A completed physician certification statement must be provided for a non-emergency transport to be covered. As an example, if you take an EMSA ambulance to the doctor's office for a flu shot it will not be covered by TotalCare.

7. Are there any excluded services?

Yes. The EMSAcare program does not provide benefits for non-emergency transports without a physician certification statement. Also, repetitive transports for services such as dialysis, radiation therapy, and chemotherapy are not included. EMSAcare does not cover non-emergency transports to and from doctors' offices, dentists' offices, physical therapy centers, and other facilities. Transports outside of EMSA's service area are also not included. It's a good idea to call EMSA at (918) 396-2888 to discuss eligibility before requesting non-emergency service.