Quoted from mikechristine1

I have a question about this ambulance issue.

And I speak from more knowledge I guess about the city (of Schenectady).  You have a medical emergency.  You call 9-11.  They dispatch the paramedic/emergency medical from the government fire dept who in turn I guess contacts the ambulance if transport is needed. (I think I've got that right).

In Rotterdam, if we call 9-11, do our volunteer fire commpanies respond and then call the Rotterdam ambulance?  Or is Rotterdam ambulance dispatched directly from our 9-11 call and since they are also ambulance they transport from right there?  

If we had Mohawk Ambulance, would they move some ambulances into the existing locations that REMS has?  Or would we be waiting for them to arrive from their Hamilton Hill location?

Unless the nature of the medical emergency involves a fire department operation, Rems is directly dispatched, along with our
paramedics in a potential ALS situation. If REMS does not respond for some reason, Mohawk provides back-up service...our
paramedics would still be dispatched for ALS. In the event that our paramedics cannot respond for some reason, Mohawk covers ALS.

If Mohawk were to be the town wide provider of ems, they would purchase one of the buildings out of which REMS is currently
operating...likely the building next to the RPD, as the towns presently owns that property and would be free to sell...whereas the
building under REMS ownership would likely be seized and sold by the IRS, and any proceeds would be applied to their current tax
debt. Mohawk would house an ambulance with staff 24/7 in the acquired building, essentially establishing a substation in Rotterdam.

i will be absolutly SHOCKED if Mohawk staffs Rotterdam full time.  They dont staff Glenville and REMS does what?  3000 calls a year?

Even if they do, we will be trading 2 ambulances + 2 paramedics  (4 response vehicles ) from REMS for 1 ambulance from mohawk.  When more then 1 call goes out around the same time, mohawk will be sending a rig from State st in Schenectady

Quoted Text

Does Medicare pay for ambulance services?

Section IV.b. Ambulance Services (Part B)
Question 1 of 5 (use "Last" or "Next" buttons to see more)
Last Update: August 11, 2008
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If it is an emergency Medicare will generally cover ambulance services, as long as:
An ambulance is the only safe way to transport you (medically necessary); and
You are transported to and from certain locations.
If it is not an emergency, Medicare coverage of ambulance services is very limited.
An emergency is when your health is in serious danger and every second counts to prevent your health from getting worse. If the trip is scheduled as a way to transport you from one location to another when your health is not in immediate danger, it is not considered an emergency.

Note: Medicare will never pay for ambulette services.

Medicare may cover non-emergency ambulance services if:

you are confined to your bed (unable to get up from bed without help, unable to walk, and unable to sit in a chair or wheelchair); or
you need vital medical services during your trip that are only available in an ambulance, such as administration of medications or monitoring of vital functions; or
the hospital where you are receiving treatment is local, or is the closest facility that can provide the treatment you need; or
the cost of bringing treatment to your home is less than the cost of transporting you to the hospital and back by ambulance (for frequent trips, Medicare may require proof that the regular ambulance trips are more appropriate than hospitalization; or
the ambulance meets Medicare requirements.
Note: Lack of access to alternative transportation alone will not justify Medicare coverage.

If covered, Medicare will pay for 80% of its approved amount for the ambulance service. You or your supplemental insurance policy will be responsible for the remaining 20%. All ambulance providers must accept Medicare assignment, meaning they must accept the Medicare-approved amount as payment in full.

http://www.medicareinteractive.org/page2.php?topic=counselor&page=script&slide_id=1246

You're forgetting the police paramedics that respond first then the ambulance arrives.

For all those seniors at the senior center that are being told only the pro taxing district story, they need to take a look at the medicare insurance(if they have it) and understand that ambulance service is covered.  Paying extra property tax for an ambulance taxing district would be paying for a service they pay for in their insurance premium.

http://www.emedny.org/ProviderManuals/Transportation/PDFS/Transportation_Manual_Policy_Section.pdf


Above is a link to the Medicaid allowable reimbursement for ambulance services. It is quite detailed.

So if Medicaid covers ambulance service, Medicare covers ambulance service, and private health insurance covers ambulance service, how is a non profit like REMS insolvent, and Mohawk, which is for profit maintain profitability?  

This whole taxing district is all about getting money for salaries, new equipment, and new ambulances that REMS can't pay for because they don't make enough money.

Are the REMS balance sheets public information?  Can we FOIL for them?  I'd like to see their accounts payable and receivable.  I don't understand why we would grant a taxing district for such a mismanaged organization.

When an ambulance service stands before the taxpayers and states that it is not only in debt, but can't survive without taxpayer's money.....well, that's a no brainer.

Also, rems should be ashamed of themselves for spewing untruths and using fear tactics at the senior center. Even the seniors are already paying for this service through their medicare and if they have one, a supplemental insurance policy. Now rems wants even more of their money. They should be ashamed! IMHO

What's next? Taxpayer's paying for people's co-pays when someone goes to the doctor or hospital? This is just plain nonsense!

Quoted from 680

i will be absolutly SHOCKED if Mohawk staffs Rotterdam full time.  They dont staff Glenville and REMS does what?  3000 calls a year?

Even if they do, we will be trading 2 ambulances + 2 paramedics  (4 response vehicles ) from REMS for 1 ambulance from mohawk.  When more then 1 call goes out around the same time, mohawk will be sending a rig from State st in Schenectady

Then I would suggest surrounding yourself with materials that do not conduct electricity.

We would not lose 2 paramedics...Rotterdam paramedics would still be the first responders when available. Mohawk has all of the
backup necessary in the event of simultaneous emergencies. Regardless of where they are dispatched from, they maintain response
times well within accepted national standards. It should also be noted that a significant number of residents already call Mohawk
directly...and they are responding in a timely manner.

Glenville is not staffed because there is no substation there to staff.

Quoted from CICERO

Are the REMS balance sheets public information?  Can we FOIL for them?  I'd like to see their accounts payable and receivable.  I don't understand why we would grant a taxing district for such a mismanaged organization.

If you saw the latest audit of their finances it would make your head spin...and it doesn't even include their IRS nightmare.

Quoted from CICERO

http://www.emedny.org/ProviderManuals/Transportation/PDFS/Transportation_Manual_Policy_Section.pdf


Above is a link to the Medicaid allowable reimbursement for ambulance services. It is quite detailed.

So if Medicaid covers ambulance service, Medicare covers ambulance service, and private health insurance covers ambulance service, how is a non profit like REMS insolvent, and Mohawk, which is for profit maintain profitability?  

The answer is because, especially with Medicare and Medicaid, these two govermenmt programs pay SUBSTANTIALLY less than the full and real cost.   And I trust you keep hearing on the news that the government is cutting health care, just like the state budget extender a few week ago.


I'll tell you, My dad and I go to the same doctor.  I have a health insurance plan that I get a benefit statement.  Go to the doctor for a given office visit.  My insurance pays 80% of reasonable and customary.  So, imagine for the moment the deductible has already been met.  If a certain level office visit the doctor bills $100, my plan pays 80% and while it says "of reasonable and customary" I have NEVER in all my 25+ years experienced my plan saying that the amount the doctor charged was not reasonable and customary.  Now, with medicare and my dad (who has traditional medicare rather than a medicare advantage plan), for the same doctor and for the same CPT code, Medicare pays a small portion of that cost.  That means that the doctor charges the $100, medicare's "approved amount" might be $45 and then medicare pays the doctor 80% of the approved amount, which is $36 paid by Medicare to the doctor.  Of course dad has to come up with the other $9.   And that other $55, well, that get's spread among all patients.  So, when the landlord of a building where a doctor has his/her practice increases the rent, and when the doctor has to give the lowly file clerk a ten cent an hour raise, and when Nat Grid raises rates, and when the cost of those paper gowns, cotton balls, plastic gloves, etc increases, well, the doctor may need to increase fees because prices are going up to begin with, but also because the government is reducing the reimbursement rates under medicare and medicaid.   (No, I do not have a doctor in my family)

The blame falls squarely on the GOVERNMENT!!!! This is why people didn't want national healthcare!!! The government sucks at it! You have an issue with the medicare payments? Call you representative and tell him/her to take it to the alter of the oval office!!

It is the GOVERNMENT that has put us in this position. AND we allowed it!

Your dad is already paying for medical coverage....he should not have to pay AGAIN, through his taxes!!!

Again.........take it up with the government!!! And get use to it, cause in the next few years we ALL will be in the same boat with national health care. Ya think people would have learned with the failed medicare program!!!!

Let's try to put some sense back into this health care. Even if it is just an ambulance service. PRIVATIZE IT!!! Don't vote for a taxing district that will again put government in charge of a portion of our health care. HASN'T ANYONE LEARNED YET????

Quoted from bumblethru

What's next? Taxpayer's paying for people's co-pays when someone goes to the doctor or hospital? This is just plain nonsense!

What do you think happens with people on medicaid?   Well, it happens in a different way.  We go to a doctor at a $100 office visit charge, insurance reimburses us 80% of R&C, so we pay out of our pocket 20% (or $20 in this example).  Or we might be in an HMO and perhaps we have a $20 co-pay and the HMO plan has a contract with his par par providers to pay them, say, $70 for that same office visit.   When medicaid might pay $30 to the doctor for an OV charge that is really $100, we all cover that cost.  If medicaid reduces it's reimbursements, doctors will increase the charges to the patients and if doctor's charge then becomes $110, well I'll tell you, if your insurance plan says only 80% is reasonable and customary and your plan says they call only $100 as reasonable and customary and then reimburse you only $80 , you will have an easy time appealing it, if all doctors increase their costs to $110, you will be able to completely justify that your plan owes you $8 more.  Reasonable and customary is defined as the provider's normal charge for a certain service in a given geographic area.  If all doctor's charge $110 for CPT code 12345 in the Schenectady/Albany area, then you have a valid argument with your insurance company that $110 is reasonable and customary instead of $100.  So, since the government is cutting payments to doctors, but the doctor still needs to give that file clerk a 10 cent raise and has to pay an increased rent, etc, the doctor increases the charge to you, to all of us, who, in effect, cover the amount that medicaid and medicare does not pay for

Quoted from CICERO

Are the REMS balance sheets public information?  Can we FOIL for them?  I'd like to see their accounts payable and receivable.  

This is something that I would be interested in.  

I'm using made up numbers in this example but it better explains what I'm getting at.  Suppose Mohawk has 5 ambulances and 5 employees and responds to 5,000 calls in a given period of time and get's paid $100 per trip, how do their finances look.  THen suppose Rotterdam has 2 ambulances, 2 employees, and reponds to just 300 calls in a given period of time and get's paid $100 per trip, how would their finances look?

That's kind of the difference between a one income family of 4 and a two income (each income is identical) family of 4, living next door to each other in the same identical house purchased at the same time for the same cost, which family can budget easier.

Next question.  and again, it's an extreme example.  Suppose there was only one call in a period of a year to Rotterdam Ambulance, then their total revenue would be $100 but how much would they pay in fuel in a year?   So, in this discussion should we be taxed to keep it in existence.  

Somethingt else to consider.  With this ambulance issue, will REMS become a government ambulance service?  I'm not positive, but I think many insurance plans exclude payment for services rendered by the government.  Often a clause in insurance certificates.  

So much to think about, so many answers needed.  But to me, the bottom line is that ALL town residents who are old enough to vote and have chosen to register to vote (for president, gov, local, propositions, etc) should be allowed to vote regardless of whether they send a check directly to the town for taxes or whether they pay taxes via sending their check to a landlord who in turn writes out the check to the town.  And today, many graduate from college, job prospects are tough so kids live at home but their name is not on the deed - they may need an ambulance, they should also have a voice

On the other hand