CLARKSVILLE RESIDENT BENEFIT PROGRAM
What is the Resident Benefit Plan?
The Resident Benefit Program (“the program”) provides for the prepayment of co-payments and deductibles for ambulance service provided by LifeNet. In addition, participating residents pay a reduced rate of 40% off the regular cost for medically necessary ambulance service provided by LifeNet that is not covered by a third-party payer.
How does it Work?
Beginning on February 1, 2015, every water utility holder (within city limits) will be automatically enrolled in the program and are charged $6 per month. Customers have the option to “opt out” of the program.
Who Is Covered?
Benefits apply to the utility account holder and all permanent members of their household. A spouse being cared for in a nursing home will receive benefits under the account holder’s program.
PROGRAM BENEFITS
For residents with Medicare or residents with private insurance that pays a portion of the ambulance charges — LifeNet will accept the payment from Medicare or that insurer as payment in full. The resident will not have any responsibility for any deductible or coinsurance assessed by their insurance. If Medicare or the private insurance denies the service as “non-covered”, the resident will receive 40% discount on billed charges.
For residents without Medicare or private insurance — The resident will receive a 40% discount on billed charges.
For non-residents — LifeNet will bill Medicare or the private insurance, and will bill the non-resident for 100% of any deductibles and coinsurance assessed by Medicare or the private insurance. If Medicare or the private insurance denies the service as “non-covered”, the non-resident will be responsible for 100% of billed charges.
For residents with Medicare or residents with private insurance that pays a portion of the ambulance charges — LifeNet will accept the payment from Medicare or that insurer as payment in full. This means that the resident will not have any responsibility for any deductible or coinsurance assessed by your insurance. If Medicare or the private insurance denies the service as “non-covered”, the resident will receive 40% discount on billed charges.
For residents without Medicare or private insurance — The resident will receive a 40% discount on billed charges.
For non-residents — LifeNet will bill Medicare or the private insurance, and will bill the non-resident for 100% of any deductibles and coinsurance assessed by Medicare or the private insurance. If Medicare or the private insurance denies the service as “non-covered”, the non-resident will be responsible for 100% of billed charges.
For residents and non-residents — LifeNet will bill Medicare or the private insurance, and will bill the non-resident for 100% of any deductibles and coinsurance assessed by Medicare or the private insurance. If Medicare or the private insurance denies the service as “non-covered”, the non-resident will be responsible for 100% of billed charges.**
** LifeNet reserves the right to refuse service for non-emergency transports that are not ordered by a physician or other qualified medical professional.
Program participants must present a completed physician certification statement (PCS) to receive benefits for non-emergency transports. Patients receive no benefits for non-emergency transports without a PCS. The patient’s physician usually completes certificates. A non-emergency transport is a medical transfer that does not have a hospital emergency room as the final destination.
Repetitive transports for services such as dialysis, radiation therapy and chemotherapy are not eligible for benefits without additional screening and insurance approvals.
The program does not cover non-emergency transports to and from doctors’ offices, dentists’ offices, physical therapy centers, pharmacies, freestanding clinics and other non-hospital facilities. Transports outside of the LifeNet service area are also not included in the program. Program participants will receive a full bill for excluded services.
PROGRAM FAQ
All residents of participating households, regardless of their age or whether they are a blood relative of the utility account holder, receive benefits. Persons must live at the participating household address to be covered. Someone simply in town visiting is not covered. A good test is whether the person receives bills and mail at the address.
Yes, but you will personally responsible for paying full charges ($1,000 – $1,200) for LifeNet ambulance service.
The Resident Benefit Program is available for $6 per month, which is conveniently included on your municipal utility bill. This fee covers the utility account holder and all permanent members of the household.
Because Medicare, Medicaid and insurance companies don’t always pay full charges – and deny about 25% of ambulance claims outright! If you participate in the Resident Benefit Program, LifeNet will bill your insurance, Medicare or Medicaid provider and accept their payment as payment-in-full. You will not have to pay the usual 20% Medicare copayment, a standard insurance deductible or a balance after a partial payment. If your provider denies a claim outright or if you don’t have coverage, you’ll be charged a reduced fee (40% off the standard rates).
Yes. The Resident Benefit Program does not provide benefits for non-emergency transports (a medical transfer that does not have a hospital emergency room as the final destination) without a physician certification statement. Also, repetitive transports for services such as dialysis, radiation therapy and chemotherapy are not included without proper documentation. The program does not cover non-emergency transports to and from doctors’ offices, dentists’ offices, physical therapy centers and other non-hospital facilities. Transports that begin outside of the LifeNet service area (Red River and Bowie County) are also not included in the program..
No. Once you have made your choice to stay in the program or opt out, that decision will carry forward until such a time that you elect to enroll.erage.
No. A participating utilities customer does not need to purchase an individual membership for a spouse in a nursing home.
No. The Resident Benefit Program does not afford benefits to utility account holders, but rather to individuals living at participating addresses.
All accounts are automatically enrolled in the Resident Benefit Program; only the utilities account holder has the ability to opt an account/residence out of the program. If your landlord/the utility account holder opts out the residence where you are living, you may purchase an individual membership to receive benefits.
Since the temporary service agreement states that no one will be living at the location under this agreement, the account would not be charged.
If the utility account is in permanent service rather than temporary service you will still have to opt out to avoid the charges.
Nursing homes and assisted living facilities are not classified as residential utility customers. This program is available only to residential utility customers.
Your program benefits will apply to transports within the LifeNet service area. If you need an ambulance while at work – or if you’re on vacation in another state, for that matter – a different ambulance provider will respond and you may be responsible for paying out-of-pocket charges.
They are charged a reduced fee (40% off the standard rates) after a transport.
Go online to www.lifenetems.org and print out and complete a RBP Refusal form. Mail or deliver the form to the City.
We will give you a prorated refund. If you bought the subscription six months we will give you a 50% refund. Send in the refusal form stating they are a LifeNet subscriber. At the time of renewal you can choose to use the water bill auto draft at that time.
No, you will need to buy a separate Air subscription.
No, however if you do not send in the refusal form the auto draft will be effective February 2015.
The water utility company doesn’t have a record of current LifeNet members so if you don’t send in your refusal forms it is possible that you could double pay. LifeNet can prorate your subscription and send you a refund. Please call our office for details.
Send in the refusal letter for automatic draft and continue to pay LifeNet your annual subscription.
No, the only plans that can be auto draft on your water bill is the basic LifeNet subscription that does not include air coverage. You can either go online and complete the form or have a subscription application mailed to you and then you would pay LifeNet.
Yes, you will need to contact the water utility company.
You will have a choice of Paris Regional Hospital or Titus Regional Medical Center Mt Pleasant.