ComplaintsforEmergicon

• Initial Complaint

  05/21/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Under Txas Law I am not responsible for the charges in access of insurance payment Ambulance vehicle was substandard and machines were not working the attendents could not administer iv or heart monitor

  Business response

  05/29/2024

  Emergicon, LLC (Emergicon) is not an emergency care provider, as that term is defined in Tex. Ins. Code ?1467.001(2-d); rather, it provides billing services for EMS providers. Neither The Colony EMS nor Emergicon has a contract with your insurance company. According to the patient's Explanation of Benefits, $495.00 has been applied to the patient's coinsurance.
  Pursuant to Texas Senate Bill 2476, we have billed the patient only for the coinsurance related to these services. Due to HIPAA regulations, I have omitted any specific information that might apply to the patient.
  Lastly, Emergicon acknowledges the patient's  debt dispute. We are fully aware of our obligations under the Texas Debt Collection Practices Act, including Tex. Fin. Code ***. *******, and will proceed as permitted by law.
  For the aforementioned reasons, Emergicon fully expects that the patient will pay the $495.00. Emergicon will proceed as permitted by law and as instructed by The Colony EMS to seek payment for the amount due. The patient is welcome to call me at ************ to discuss payment options and any concerns that could not be addressed here due to HIPAA restrictions.

• Initial Complaint

  07/30/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On 4 different occasions, the Comanche County Ambulance had to come to my home because I was having extreme heart problems. Each time, they just sat in my driveway for some time. Once my pulse got down to 30 bpm and the tech on board thought her keg machine was not working. No, that's what a heart does when it finally gets out of an SVT. Then on one occasion, a tech opened my vein for some saline but forgot to clip it and I bled out all over the ambulance floor. All of this was last summer. It took 3 trips to the ** before an old doctor there diagnosed me with Supraventricular tachycardia. I could have died in my driveway. My insurance paid them at 50% because I didn't know that they were out of network. But I had no choice as my husband works out of state and I was alone. The last time I called them I was withdrawing from a benzo. But I didn't realize what was going on. They, the ambulance service called a police officer to my home. The ** at the ***************** tested me for 15 illicit substances. I was negative on them all. But they did nothing for me at all in the ambulance or the **. Now they have sent the balance they say I owe Emergicon, who is the billing entity for the ambulance service to a collections agency that has put it as collections on my credit report. This was a life-threatening, horrible experience for me. Then they tried to make me pay the full balance. That is surprise billing. They got mad when I said I would not pay the full balance.

  Business response

  08/14/2023

  Is the patient given Emergicon on behalf of  ******************* permission to release PHI information not limited to remittance notice , medical information and billing information to reply to this compliant? 

  Business response

  08/14/2023

  First, Emergicon is not an emergency care provider, as that term is defined in ***. Ins. Code 1467.001(2-d)--it merely provides billing services for EMS providers. Emergicon does not have a contract with United Healthcare,nor to my knowledge, does Commanche County EMS .Second, your presumed reliance on ***** Senate Bill **** ("S.B. ****") (codified throughout the ***** ********* Code, e.g., TEX.INS. CODE ******** (HMO), 1301.053 (EPO), ******** (PPO), 1551.228,1575.171, ********) and Congress' No Surprises Act (the ****** (codified as 42 U.S.C. 300 gg, et seq.)--neither of which you expressly reference--are misguided.  S.B. **** does not apply to ground ambulance services. Indeed, ground ambulance
  services are mentioned nowhere within the statute. The ***** ********** of *********'s website reiterates this precept--S.B.**** does not apply to ambulance.  services: Further, the ********** of ********* clarified that the definition of "emergency care" as  used in S.B. **** has the meaning provided by TEX. INS. CODE ***. ********. This section defines "emergency care" as "health care services provided in a hospital. emergency facility, freestanding emergency medical care facility, or comparable emergency facility to evaluate and stabilize a medical condition . . .." ***** services not provided within a facility, such as ambulance services and air ambulances services, are. not included in the meaning of "emergency care."
  The current exclusion of ground ambulance services from ***** and federal balance billing laws was also recently highlighted during the 2021 ***** legislative session. The Bill ******** for ***** Senate Bill 999 (which did not pass), reiterated that existing ***** and federal law do not impute any balance billing requirements on ground ambulance services:

  
  11/02/2021 Emergicon is the billing company for Comanche County. We negotiated with your insurance company on behalf of Comanche County, out of network, a payment of $742.00 for Basic life Serves (BLS). Your insurance paid $371.00 and applied $371.00 to your co-insurance (you owe). You called Emergicon's office on 10/26/2022 to confirm the balance and would make monthly payments on all three runs with no complaints. Two payments were made for ******, leaving a balance of $171.00.
  I was not on-site at the time of transport, and from the documentation provider,the crew on the scene followed treatment protocols set by the medical director.The crew documented that they checked your vitals, monitored the assessment,and transported the patient. The patient's mobility was monitored during transport.
  You are stating that the services rendered to you was not medical necessary and you could be transported to the hospital by other means without causing injury to yourself or other, then Basic Life Support (BLS) service will not be covered by your insurance, and you will be responsible for total bill amount. 

  
  6/30/2022 Emergicon, the billing company for Comanche County, we negotiated with your insurance company on behalf of Comanche County being out of network a payment of $1534.40. Patient insurance paid $767.20, patient share $767.20. 
  I was not on-site at the time of transport, and from the documentation provider,the crew on the scene followed treatment protocols set by the medical director for the patient's signs and symptoms. The patient was given an ECG and IV therapy and was transported to the hospital for care.  The patient was mailed two letters on 8/05/2022 and 09/10/2022, at the patient's request on 10/27/2022. The patient called Emergicon on 09/29/2022 to talk about the bill and was upset about the balance and was requested to speak to her insurance company about the balance on the account, and the patient called back on 10/27/2022 stated she would be making monthly payments and again on 07/26/20213 said she would pay $300 down and then ****** a month until paid was told at this time she would have to pay collections agency at this time. No payments have been reported at this time.

  
  07/24/2022 Emergicon, the billing company for Comanche County, we negotiated with your insurance company on behalf of Comanche County, being out of network, a payment of $1096.00.********* paid ****** pt share of $******.
  I was not on-site at the time of transport, and from the documentation provider,the crew on the scene followed treatment protocols set by the medical director for the patient's signs and symptoms. The patient was given an ECG and IV therapy and was transported to the hospital for care. The patient mailed two letters on 10/18/2022 and 11/22/2022. 

  
  09/11/2022 -Emergicon, the billing company for Comanche County, negotiated with your insurance company on behalf of Comanche County, being out of network, a payment of $1592.00. ********* paid $397.99; the patient share $398.01.
  I was not on-site at the time of transport, and from the documentation provider,the crew on the scene followed treatment protocols set by the medical director.The crew documented that they checked your vitals, assessment monitor and transport you of your person your mobility monitored you through transport.

  
  As you can see, we are not balancing billing the patient. We only bill her for the deductible/copy- coins her insurance listed on the attached remittance. We are happy to have the collection agency set up payment plans on the four dates of services in question if the patient calls PMAB at ************. 

  
  Thank you, 

  
  ***********************

  *********************

• Initial Complaint

  10/26/2022

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  on September 20,2020 I was taken by ambulance from my home to ****** medical center. I was then transported to ***** medical center where I spent several days in ICU. On July 12, 2022 I received a notice from a collection agency that I owed $1,117. I disputed the claim. an additional letter was sent on August 4, 2002 stating that the **********************. after speaking with Emergicon they stated that letters were sent by****. I never received a bill- the address they sent it to was in Flower Mound. I have never lived in Flower Mound. They said my voicemail box was full so could not leave a message. my voicemail box is never full. they also said the hospital said I was a self pay patient. This is also incorrect. The ****** Hopsital and doctors who worked on me filed with the correct insurance and submitted claims in a timely manner. The bill from the collect ion agency was sent well out of compliance for me to submit a claim through my insurance. I feel I do not owe money to this agency due to the**** provider not attaining the correct information in a timely manner. The collection agency tells me that It is now out of the hands of the ********************** services and that I owe them in full. I want to dispute this payment. I feel I do not owe any of the money- as I can't submit to my insurance any longer.

  Business response

  03/20/2023

  Business Response /* (1000, 7, 2022/11/21) */ Thank you for the inquire we are looking into this matter and will have a reply soon. Consumer Response /* (3000, 9, 2022/11/23) */ (The consumer indicated he/she DID NOT accept the response from the business.) The response just states they are looking into the matter. I will wait for further responses. Thank You! Business Response /* (4000, 13, 2022/12/20) */ The claim has been adjusted off and removed from collections. Consumer Response /* (2000, 15, 2023/01/03) */ (The consumer indicated he/she ACCEPTED the response from the business.) I agree and appreciate that this claim is dismissed and removed from collections.

• Initial Complaint

  10/21/2022

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  My daughter was transported by Walker County EMS after passing *** at a cross country meet in Huntsville, TX. (Run #XXX-XX-XXXX:X) on 10/25/2021. I provided insurance information and was responsible for a $100 deductible. On 1/18/22 I received a bill from EMERGICON, the billing company for the ambulance service, for $1,021.19. The insurance company paid $700.81 and the above amount was the remaining balance. Around this same time I received a phone call from EMERGICON (the only call they initiated) to inform me of the outstanding balance. I discussed the issue with them who advised that I had been "balanced billed" and instructed me to contact my insurance company. They explained the insurance company would negotiate the outstanding balance. I followed those instructions and contacted my insurance company on 1/26/22. They agreed I only have a $100 deductible and opened an investigation into the bill. At this point I received no other phone calls or bills from EMERGICON or my insurance company and assumed the bill had been resolved. In August of 2022 I received a notice from a collection agency of an outstanding balance of $550. I called my insurance company who advised they paid an additional payment in Feb of 2022 and wasn't aware of an outstanding balance. The insurance agent and I conference called EMERGICON but no answer. We left message with both of our contact #s but I did not receive a return call. On 10/17/22 I was able to speak with EMERGICON who explained "Disposables" was not paid by insurance. There was no explanation why I was not contacted (by phone) before turning over to collections. She apologized for lack of communication and advised she would request the balance be removed from collections while I appealed the matter with insurance. She advised she would call me back with the outcome within 24 hrs. That did not happen. I called on 10/19/22 and another employee claimed they could not remove from collections despite their shortcomings.

  Business response

  12/30/2022

  Business Response /* (1000, 5, 2022/10/28) */ First, Emergicon is not an emergency care provider, as that term is defined in Tex. Ins. Code § 1467.001(2-d) merely provides billing services for EMS providers. Emergicon, on behalf of Walker County, mailed three letters to the billing address we have on file before sending your account to collections. Emergicon does not have a contract with Cigna, nor to Emergicon's knowledge, does Walker County. We have reviewed the billing guidelines set by Walker County EMS and will adjust the supplies not covered by your insurance. We will notify the collection agency that the balance of the account in question is one hundred dollars. You can call 972-602-2060 to make a payment. Consumer Response /* (2000, 7, 2022/10/31) */ (The consumer indicated he/she ACCEPTED the response from the business.) I understand Emergicon is not the emergency healthcare provider and simply the billing company. My issue with EMERGICON was not related to balance billing but the lack of communication with me to collect outstanding payments. You claimed 3 letters were sent out but they were never received. The only communication we received was a phone call in January of 2021 and we promptly contacted the insurance company to get matter resolved. Any unpaid balance for "disposables" was not relayed to us until we received collection notice. Before reporting a customer to collections there should be at least one attempt to contact by phone and/or perhaps certified mail. This matter got resolved once we became aware of it and the collection process was not necessary. I am satisfied with outcome but hope the company becomes more diligent in their billing/collection processes in the future.

• Initial Complaint

  06/09/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On January 25, 2022, I was transported by an ambulance from my house to HEB hospital which is 2.6 miles in distance. No disposable items were used on me, none. Emergicon is the billing company for the city of Bedford and they submitted the claim to ****** Healthcare (my insurance) on March 3, 2022. The claim was submitted under wrong coding and reprocessed by *** on 3/29/2022. My insurance *** paid $645.00 and denied part of the claim for disposable supplies. There is an explanation for why that part of the claim is denied "benefits for this service are denied. This billing doesn't comply with national industry coding and payment standards. We've sent you a letter with additional info. Provider: this decision was made by Medical Audit & Review Solutions ******* On behalf of ***. DO NOT BILL THE PATIENT FOR THIS SERVICE". They were also sent EOB that says "based on national coding and payment standards, ***** life support routine supplies (code ****** is bundled into the ambulance transport service when reported by the same provider. (Source: Payor Policies). Since this is an out of network service ********* was negotiating the claim with them and the result was that I owed $0.00 to Emergicon. Despite all of the info that they have received in writing, they keep sending me the bill for *** Disposables ***** for $250.00. On June 1st, I emailed Emergicon and asked for an itemized bill for this charge. An itemized bill breaks down the total amount and states every item with a detailed description. I received an email the following day from D. ******* - Patient Accounts Specialist that says "That is the itemized charge, and we do not bill supplies individually. Charges for supplies used during transport and correspond with the level of service provided. I do have another invoice sent to your address today to reflect that charge". She is literally saying that they do not charge for disposables and sends me a bill to $250.00 for disposables. All proof will be provided.

  Business response

  08/24/2022

  Business Response /* (1000, 5, 2022/06/21) */ First, Emergicon is not an emergency care provider, as that term is defined in Tex. Ins. Code § 1467.001(2-d)it merely provides billing services for EMS providers. Emergicon does not have a contract with ****** Healthcare, nor to my knowledge, does City of ******* (a municipality). Accordingly, neither Emergicon nor City of ******* are contractually or statutorily required to honor any discount ****** Healthcare applied to the Explanation of Benefits. Second, your presumed reliance on Texas Senate Bill 1264 ("S.B. 1264") (codified throughout the Texas Insurance Code, e.g., TEX. INS. CODE §§ 1271.155 (HMO), 1301.053 (EPO), ******** (PPO), 1551.228, 1575.171, 1579.109) and Congress' No Surprises Act (the "NSA") (codified as 42 U.S.C. § 300 gg, et seq.)neither of which you expressly referenceare misguided. S.B. 1264 does not apply to ground ambulance services. Indeed, ground ambulance services are mentioned nowhere within the statute. The Texas Department of Insurance's website reiterates this preceptS.B. 1264 does not apply to ambulance services: Further, the Department of Insurance clarified that the definition of "emergency care" as used in S.B. 1264 has the meaning provided by TEX. INS. CODE ANN. § ********. This section defines "emergency care" as "health care services provided in a hospital emergency facility, freestanding emergency medical care facility, or comparable emergency facility to evaluate and stabilize a medical condition . . .." Thus, services not provided within a facility, such as ambulance services and air ambulances services, are not included in the meaning of "emergency care." Additionally, while the NSA applies to air ambulance services, similar to S.B. 1264, it has no application to ground ambulance services. The current exclusion of ground ambulance services from Texas and federal balance billing laws was also recently highlighted during the 2021 Texas legislative session. The Bill Analysis for Texas Senate Bill 999 (which did not pass), reiterated that existing Texas and federal law do not impute any balance billing requirements on ground ambulance services: If you would like to discuss payment options, you can contact ****** ***** at XXX-XXX-XXXX Ext 445. Consumer Response /* (3000, 7, 2022/06/28) */ (The consumer indicated he/she DID NOT accept the response from the business.) What I have received through your answer is all the loopholes and how you take advantage of them. I am very well aware of all of it and that you're not in network with *** and that's why********** was negotiating on behalf of *** because one more time, you are not in network with ***. That being said, it does not exempt you from following the national/industry coding and payment standards if you are a legal billing company in the USA. *** does not set those standards but you still have to follow them in network or not, it doesn't matter. Based on national coding and payment standards, ***** life support routine supplies (code A****) is bundled into the ambulance transport service when reported by the same provider. (Source: Payor Policies). Which basically means you're payed the ambulance transport service and in that payment you're automatically payed for ***** life support routine supplies (BLS disposables). This means that you can't charge me for ***** life support supplies (BLS disposables) because they are already payed to you. Also, I asked for an itemized bill (which by law I am supposed to be provided for the ***** life support supplies) but I never received it. I received just another bill and an email from a patients account specialist that says: "That is the itemized charge, and we do not bill supplies individually. Charges for supplies used during transport and correspond with the level of service provided. I do have another invoice sent to you address today to reflect that charge. An itemized bill breaks down the total amount and states every item with a detailed description. Summary: You don't comply with national/industry coding and payment standards and I am being charged with something that *** already payed to you when they payed ***** life support ambulance. I did not receive an itemized bill for this $250 which I legally was supposed to be provided. Your Patient Accounts Specialist is saying that you do not bill supplies individually which is exactly what you're doing in this case. I am asking why? Since this service has already been payed for,( by ***) please dismiss this charges.

• Initial Complaint

  05/24/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  4/23/2021--EMS/Ambulance ride to Texas Health Hospital Surprise bill from Emergicon/Town of Little Elm for $1684.00 due to ambulance being OUT OF NETWORK I had no idea that the ambulance would be out of network--I called for help because I was in crisis. Life or Death situation. Emergicon would not work with my insurance company to reach a compromise that would reflect the working relationship that EMS companies have with major insurance companies. Navigard/United Healthcare reached an agreement with Emergicon for $733.04 Emergicon never sent an invoice for that amount and continued requesting different amounts that were much higher. Emergicon sold the debt to a collection agency that is still requesting the incorrect billing amount. Driving distance 3.8 miles and 7 minutes

  Business response

  07/01/2022

  Business Response /* (1000, 5, 2022/05/26) */ Contact Name and Title: ****** R****/ Compliance Contact Phone: ************ Contact Email: ******************** First, Emergicon is not an emergency care provider, as that term is defined in Tex. Ins. Code § 1467.001(2-d)it merely provides billing services for EMS providers. Emergicon does not have a contract with United Healthcare, nor to my knowledge, does Little Elm (a municipality). Accordingly, neither Emergicon nor Little Elm are contractually or statutorily required to ***** any discount United Healthcare applied to the Explanation of Benefits. Second, your presumed reliance on Texas Senate Bill 1264 ("S.B. 1264") (codified throughout the Texas Insurance Code, e.g., TEX. INS. CODE §§ 1271.155 (HMO), 1301.053 (EPO), 1301.155 (PPO), 1551.228, 1575.171, 1579.109) and Congress' No Surprises Act (the "NSA") (codified as 42 U.S.C. § 300 gg, et seq.)neither of which you expressly referenceare misguided. S.B. 1264 does not apply to ground ambulance services. Indeed, ground ambulance services are mentioned nowhere within the statute. The Texas Department of Insurance's website reiterates this preceptS.B. 1264 does not apply to ambulance services: Further, the Department of Insurance clarified that the definition of "emergency care" as used in S.B. 1264 has the meaning provided by TEX. INS. CODE ***. § 1301.155. This section defines "emergency care" as "health care services provided in a hospital emergency facility, freestanding emergency medical care facility, or comparable emergency facility to evaluate and stabilize a medical condition . . .." Thus, services not provided within a facility, such as ambulance services and air ambulances services, are not included in the meaning of "emergency care." Additionally, while the NSA applies to air ambulance services, similar to S.B. 1264, it has no application to ground ambulance services. The current exclusion of ground ambulance services from Texas and federal balance billing laws was also recently highlighted during the 2021 Texas legislative session. The Bill Analysis for Texas Senate Bill 999 (which did not pass), reiterated that existing Texas and federal law do not impute any balance billing requirements on ground ambulance services: If you would like to discuss payment options, you can contact ****** ***** at ********************.

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