AMR allegedly overcharged partners more than $35,000 since 1998
By Jodi Rogstad
Wyoming Tribune-Eagle
Copyright 2007 Cheyenne Newspapers, Inc.
All Rights Reserved
CHEYENNE, Wyo. — Local ambulance provider American Medical Response has overcharged WINhealth Partners for its services by more than $35,000 since 1998, the health insurance firm says.
Some of these costs were passed directly to customers, WINhealth officials add.
But AMR says it has stayed within the rates spelled out in the four-year contract that it has with Cheyenne and Laramie County.
Actually, AMR’s initial research “indicates there was under-billing,” said its spokeswoman Cynthia Wentworth.
AMR says it has asked WINhealth for the supporting documents that show there is overbilling.
But WINhealth says AMR already has them.
The dispute extends to the city of Cheyenne, which administers the city-county contract.
Not only has the city been vocal this year about AMR’s performance, there now appear to be “questionable business practices,” said Cheyenne Fire and Rescue Chief Guy Cameron.
“It’s not good news, and I don’t see an end in sight,” he added.
Mayor Jack Spiker admonished AMR, saying its billing practices are “working against the patients’ pocketbook.”
If AMR doesn’t start adhering to the contract, Spiker said he would take the matter up with the City Council.
The city also notified the Medicaid Fraud Control Unit.
“We determined the company billed the Medicaid program inappropriately,” says an April 24 letter from the unit’s director, Steven D. Olmstead.
But Medicaid is not taking action. Because it only pays a set amount for services, it says it wasn’t financially harmed.
While AMR and WINhealth are working to resolve their billing dispute, other local health insurance providers have started looking into the matter, including Blue Cross/Blue Shield of Wyoming and GreatWest.
As for patients who have taken rides in a Cheyenne ambulance, WINhealth members should definitely contact their company and “we’ll walk through it and analyze it,” said Beth Wasson of WINhealth.
To Everyone else, she said: Call your insurance provider, call the city, call AMR, “and know exactly what (you’re) being billed for.”
The billing tangle’s origin lies with three city firefighters who disputed a $77 charge for the use of a monitor for their heart attack symptoms.
But AMR heart monitors weren’t used on them. They used the city’s heart monitors — funded by taxpayers — as Cheyenne Fire and Rescue has paramedics on their squads and had responded to these calls.
AMR said it charged for interpreting the data on the monitor, but the firefighters were reimbursed.
But that dispute got WINhealth’s attention, and this spring it did an analysis of claims activity.
Wasson said AMR may be overcharging for personal care supplies, for things like gloves and masks. The city-county contract states AMR may charge market rates.
AMR tends to charge $35 or more, and to Wasson “this seems excessive.”
Insurance doesn’t pay for this, the patients do, thus they “may be being overbilled,” she said.
AMR’s response: Personal care items also cover cleaning solutions, sheets, pillow cases, towels, laundry and the staff time it takes to decontaminate the ambulance after each use, general manager Rod Chandler said.
Wasson said AMR’s practice of bundling is also an issue.
To illustrate, one bill shows AMR charged $419.53 for a basic life support transport.
First of all, that’s $135.43 more that what AMR is supposed to be charging, according to the city-county contract.
Embedded — bundled — in the $419.53 were two other procedures: an IV and a splinting spinal.
The problem: Because these procedures were bundled and not itemized, WINhealth never got a chance to evaluate these claims.
WINhealth and Blue Cross/Blue Shield both said they previously were unaware of AMR’s rate contract with the city.
At the time of this billing example, WINhealth was aware of the contract, so in this case it paid the contract amount of $284.10 - apparently never questioning AMR for the overcharge.
The result: The customer was billed an extra $135.43.
Wasson said in her letter that it seemed AMR was bundling inappropriately to get more money.
But Wentworth said bundling is an accepted practice in the industry - it’s a matter of preference within insurance companies. And AMR has a rate schedule that lists everything.
“We never received a request from WINhealth for that information,” he added.
Cameron and Spiker recently released WINhealth’s letter to AMR as well as Spiker’s response.
This spring the two had gone public with their concerns about a growing trend of too many patients and not enough ambulances to transport them in Laramie County.
Some critics questioned their motives.
During Spiker’s administration, every fleet on the fire department now has a certified paramedic. And Cameron’s predecessor, Scott Alvord, wanted to analyze the benefits of taking over the ambulance service. That idea was abandoned when county officials objected.
Because the city is administering the contract, Cameron says he has a responsibility to go public with any problems they find.
He said he s planning ahead to when AMR’s contract expires at the end of 2008.
He said he wants the city to hire a consultant to analyze the ambulance service county-wide.
He would use that information to set standards for when it’s time to enter the competitive bidding process for the next contract.