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OKC Total Care Ambulatory Coverage open enrollment set to begin

Staff Report

Every September, The City of Oklahoma City gives the city’s residents the opportunity to participate or opt out of EMSA’s TotalCare program. The opt-in/opt-out period ends Sept. 30, officials said.

TotalCare provides permanent members of a household with emergency medical transport through EMSA with no out of pocket expense. The program is just $3.65 per month and can be included on water/trash utility bill.

All permanent residents of a household, regardless of age or relation of the utility account holder will be covered.

A participating utilities customer does not need to purchase a separate membership for a spouse in a nursing home.

More than 180,000 Oklahoma City households participate in EMSA’s TotalCare program already.

The charge for a single emergency ambulance ride is now over $1,100.

The first billing cycle begins in October, which is the first day coverage begins for new participants. An emergency is defined as an unforeseen condition that requires urgent and unscheduled medical attention.

TotalCare does not cover non-emergency transports except in very limited circumstances in which a doctor orders it necessary or if third-party insurance partially pays the claim.

Repetitive transports for services such as dialysis, radiation therapy, and chemotherapy are not eligible for TotalCare benefits without additional screening and insurance approvals.

To enroll, provide EMSA with insurance, Medicaid or Medicare. To receive TotalCare benefits, provide EMSA insurance/third-party payer information and furnish any information requested by your insurance company following a transport. Out of pocket, expense is also covered by TotalCare.

It is not uncommon in Oklahoma City for residents to be confused about what town they actually live in becaseu that’s determined by which post office serving that residence. Sometimes school district assignment also confuses the issue.

The in program was established in 2009 because the cost to provide reliable service was growing faster than the City’s general fund budget could afford. The City of Oklahoma City currently funds ambulance service through its general fund, which is the same way the city pays for street maintenance, many public safety programs, and other expenses.

Funding ambulance service through a special fee frees up general fund tax dollars for other community needs, in return, citizens will receive TotalCare benefits.
Without TotalCare, the difference between the cost of operating an efficient and available ambulance services the revenues brought in by EMSA would be millions of dollars. As the population ages, these costs will continue to rise.

Costs exceed EMSA’s revenue for several reasons:

1. Medicare and Medicaid have capped reimbursement for ambulance services at levels below the cost of providing the service. In 2009, these patients represented over half of all EMSA transports.
2. Approximately 21% of those transported by EMSA were uninsured or indigent so what this program does is; provide residents a benefit, while also addressing the growing costs.

For renters it is recommended to ask property management about enrolling in the program because the property owners if the account holder.

Apartment owners are required to notify tenants if they choose to opt out of the TotalCare program. If your apartment has chosen not to participate, you can call (405) 396-2888 and sign up.

For those wishing to pt-in or out, call Utility Customer Service, (405) 297-2833.

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