Memo for fiscal year 2021, updated 2020-02-20

[Archived] Question # 16: What percent of total ambulance billing revenue comes from insurance companies and how are neighboring jurisdictions recovering costs?


What percent of total ambulance billing revenue comes from insurance companies? What are neighboring jurisdictions doing in terms of cost recovery and collections practices for ambulance billing? (Mayor Wilson)


In response to questions from Mayor Wilson concerning the percent of total ambulance billing revenues paid by insurance companies, and what neighboring jurisdictions are doing in terms of cost recovery and collection practices, the following information is provided.

Cost Recovery - The chart below shows the percentage and source of ambulance billing revenue received in calendar year 2019.  

Self-pay 32.25%
Medicare 33.25%
Medicaid 7.00%
Private Insurance 26.75%
Workers Compensation 0.50%


Medicare has a capped rate of $232 (not including mileage costs) for all transports, meaning they will only reimburse that amount per transport regardless of the actual cost to transport. 

The Collection Process - The Alexandria Fire Department (AFD) maintains a soft-billing approach by which an individual is sent three unpaid bill notices in the mail. If the collection attempt is unsuccessful after the third notice or 180 days after the date of the initial claim, invoice, or bill, the account is written off. AFD does not currently send unpaid ambulance transport bills to collections for further action.  

Fairfax County, Arlington County, Prince William County, & Loudoun County also maintain a soft billing approach. Arlington County does send delinquent accounts to the Treasurer’s Office for further review and action. The Arlington Treasurer’s Office might make additional attempts to send delinquent notices or to contact individuals with unpaid bills for payment. Accounts with unresolved unpaid balances are written off. Arlington does not send unpaid bills to collections for further action. This practice is commonly known across multiple jurisdictions as a “compassionate” or a “soft” billing policy. 

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