▼

EMSAcare

Show All Answers

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. You can do so by calling Utility Customer Service at (405) 359-4541.

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 $1,100 plus $9 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. I have Medicaid. Why should I participate?

Medicaid patients have no out-of-pocket costs for emergency ambulance service when Medicaid approves the claim. However, when Medicaid denies claims, the patient becomes personally responsible for paying EMSA's full billed charge. By participating in this program, you'd have no out-of-pocket costs for EMSA emergency transports, even when Medicaid denies the claim.

5. 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.

6. 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.

7. 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.

8. 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 (405) 396-2888 to discuss eligibility before requesting non-emergency service.

9. If I opt out but later change my mind, can I resume participation?

You can only change your election during the annual October election period.

10. If I opt out next October will I have to opt out every October?

No. Once you have made your choice to stay in the program or opt out, that decision will carry forward each year unless you contact the Utilities Department in October to change your status.

11. I pay the EMSAcare fee at my home, but my husband lives in a nursing home. Does he need a separate membership?

No. A participating utilities customer does not need to purchase a separate membership for a spouse in a nursing home.

12. I pay for utilities at my two rent homes, in addition to my residence. Are my renters covered if I only pay the EMSAcare fee on my home?

No. EMSA does not afford benefits to utility account holders, but rather to individuals living at participating addresses. Verification is made based by comparing the home address of the patient to a database of participating addresses.

13. I live at an apartment complex. How do I opt out?

Only the utilities account holder has the ability to opt out of the program. In some apartment complexes, water, trash pickup, and other municipal utilities are paid by the property owner, meaning the property owner is the customer, not the individual tenant, and thus the property owner makes the decision on the EMS utility assessment on behalf of all his tenants.

14. I have an active EMSAcare membership. What does this mean for me?

Full refunds will be provided to all participating utility customers who purchased EMSAcare 2009-2010 memberships from EMSA. Refunds will be mailed beginning in November. If you have specific questions about your EMSA membership, call the EMSAcare hotline at (405) 396-2888.

15. Will EMSA still have TotalCare?

Yes, for people living in nursing homes and in apartment complexes that opt not to participate, and for those living outside of city limits.

16. I own/operate a nursing home/assisted living facility. What does this mean for us?

Nursing homes and assisted living facilities are classified as commercial customers. This service is available only to residential utility customers. But, residents of your facility can purchase an individual membership by contacting EMSA directly. There are no group or facility-wide memberships for commercial customers.

17. I work in Midwest City (or other community EMSA does not serve), but EMSA doesn't respond out there. What happens if I need an ambulance then?

EMSA is Oklahoma's largest ambulance service, providing care in 16 communities (Oklahoma City, Edmond, Bethany, Mustang, Nichols Hills, Piedmont, The Village, Yukon, Warr Acres, Lake Aluma, Arcadia, and Valley Brook, plus Tulsa, Bixby, Sand Springs, and Jenks). Your program benefits will apply to transports within EMSA's service area. If you need an ambulance while at work — or if you're on vacation in another state — a different ambulance provider will respond and you may be responsible for paying out-of-pocket charges.

18. What about people who don't have insurance?

If they participate, they have no out-of-pocket costs for EMSA emergency service. The amount they've paid through their utilities bill is considered payment in full.

19. What if I need an ambulance while on business in Tulsa?

EMSA will respond, and your transport to a Tulsa hospital emergency room would be covered. However, an ambulance transport back to Oklahoma City from Tulsa would not be covered, as it would result in the ambulance leaving the service area during the transport.

20. I live outside of Edmond but receive an Edmond utility bill. What does this mean for me?

Only City of Edmond utility customers that reside within the Edmond city limits are eligible to participate in Edmond's program. Some other cities served by EMSA have, or are creating, similar programs.

21. Why is Edmond making this change?

There are several benefits to the new TotalCare ambulance program. Edmond residents will pay less for the program. In addition, funding ambulance service through a special fee frees up General Fund tax dollars for vital city services, such as street maintenance, maintenance of our parks, many public safety programs and other community needs.

When you have a medical emergency, there are a lot of unknowns. If you need emergency ambulance care and you participate in this program, you can know that with TotalCare, you're totally covered!