To establish a policy that allows the modifying of ambulance transport fees based on current year Department of Health and Human Service Poverty guidelines, and to abide by guidance issued by the Office of Inspector General, U.S. Department of Health and Human Services.
SCOPE:
This policy applies to those who are transported by the Tabernacle Rescue Squad who are unable to pay for their medical transportation costs for financial hardship reasons. A transported individual must not have been injured while involved in the commission of criminal activity.
Each transported individual may request one (1) hardship modification per consecutive twelve (12) month period.
The charges for EMS transport billing may be modified, based upon a demonstrated showing of an individual’s financial hardship. These procedures will ensure just and fair evaluation of a hardship waiver request as well as establish an audit trail for future use.
PROCEDURES:
1. No one will EVER be denied necessary medical transport service due to either their inability to pay or a lack of insurance.
2. Tabernacle Rescue Squad will address cases of financial hardship on an individual basis.
3. Patients who are uninsured, unemployed, homeless, or for other financial hardship reasons unable to make payments may request a financial hardship review of their transport charge. Patients, or their designee, shall complete the “Request for Transport Fee Hardship Fee Modification Form” and submit documentation to support their hardship waiver request. The form is available on the Tabernaclerescue.com web site or by calling 609-268-0671 ext. 201.
4. This fee modification application and accompanying documentation will be forwarded to the TRS appointed administrator or designee for review and decision. The Tabernacle Rescue Squad Trustees will make a final decision that will be noted on the form. The President of TRS and two Trustees (or their appointed designee) may waive all charges, reduce the charges, establish a payment plan or deny the request. All final resolutions will be communicated to the individual submitting the request.
If approved for a waiver or modification, a copy of all documentation will be made and it will be held in the Tabernacle Rescue Squad’s files for a period of ten years. The original form will be transmitted to the billing company authorizing the waiver or modification of the patient’s charges. The Tabernacle Rescue Squad will notify the patient in writing as to the final disposition of the Hardship Waiver.
