Resident/property owners need not apply, you are already members.

PURPOSE

A program established and offered to residents and visitors in the Bodega Bay FPD ambulance service zone to help defray the high cost of ambulance transportation.

Balance billing is the industry standard and practice of billing patients for the remaining (balance) portion of a bill for services rendered that the insurance carrier does not pay for.  Per policy, the Bodega Bay FPD will not bill district residents or property owners for the remaining balance.  However, the district will continue to balance bill all others that are not enrolled in the membership       program.

SCOPE

A program offered to all non-district residents of the Bodega Bay FPD ambulance service zones and to visitors of the Fire District.

POLICY         

• Cost per person $49 per year
  
  
• Cost per family $99, no maximum number of members, although members must reside in same household to be considered a family member.
  
  
• Membership is valid for a 12-month period starting one-day after payment is received.
  
  
• A receipt verifying membership will be provided to the member by the district.
  
  
• An uninsured (personal insurance) member will benefit from the membership in the same manner insured members would.
  
  
• Ambulance transport co-pay amounts are considered an agreement between an individual and their insurance carrier.  High co-pay amounts will be considered on a case-by-case basis.

By joining, members agree to abide by the terms of Agreement below.

• Definition: BBFPD Ambulance Membership is a voluntary ambulance membership program operated by the BBFPD.  BBFPD Ambulance Membership is not insurance.  All coverage for services is in addition to any medical benefits members may have.  BBFPD Ambulance Membership will bill insurance or other coverage that members may have for ambulance services costs that members may have incurred and BBFPD Ambulance Membership is entitled to all benefits paid by insurance for ambulance services rendered, up to the total dollar amount of services incurred.
  
  
• Membership Benefits: Membership covers applicable patient out-of-pocket expenses for medically necessary ground ambulance transportation to any local area hospital.  "Medically necessary ground ambulance transportation" means that the patient must be transported to a hospital for medically necessary services, and transportation in any other vehicle could endanger their health.
  
  
• Basic Membership Benefits Outside of Local Service Area: BBFPD Ambulance Membership is not responsible for the type, level, or quality of services provided by a participating agency nor is BBFPD Ambulance Membership financially responsible for any costs or charges incurred by a member from any other ambulance provider. 
  
  
• Member Responsibilities: Members pay an annual membership fee and will assign and transfer to BBFPD Ambulance Membership all rights and reimbursements for ambulance services from all insurance policies, plans, or other benefit programs members may have, including all rights in any claim or third party recovery, up to the total dollar amount of services incurred, where ambulance services were provided by BBFPD Ambulance Membership.  Should any person covered under this membership receive any payment for ambulance services rendered by BBFPD Ambulance Membership, they will immediately forward such payment to BBFPD Ambulance Membership.  Members authorize the release of medical and other information by or to BBFPD Ambulance Membership as necessary for ambulance billing.  Members agree to provide, when requested, any or all information concerning insurance policies, plans, third party recovery, or other benefit programs they may have, and will cooperate and assist as necessary in any efforts to bill and collect such ambulance reimbursements, including the completion and submission of documents or claim forms.
  
  
• Membership Eligibility: Residents of the BBFPD Ambulance Membership ambulance service area are eligible to join by properly completing an enrollment application available from BBFPD Ambulance Membership and by paying the appropriate annual membership fee.  BBFPD Ambulance Membership household membership includes all persons who are permanent residents of the same single-family occupancy, non-commercial residence, within the BBFPD Ambulance Membership service area, living together as a family unit, including domestic partners, but not to include roomers or boarders.  Others not included in this definition are required to obtain their own separate membership.  The first person listed on the application form is called the "Primary Member." Anyone who joins a household after the membership goes into effect can be included under the membership from the date the "Primary Member" notifies BBFPD Ambulance Membership of the addition.  Only those persons who meet the membership eligibility requirements AND are listed in the membership record at the time services are rendered are eligible for benefits.
  
  
• Duration: Membership coverage begins upon acceptance of a properly completed application form with payment and extends for a period of one year from the day after payment and application are received.  On-line membership payers will need to submit the application via fax or by mail.
  
  
• Disclaimer: BBFPD Ambulance Membership reserves the right to add, modify, or delete any of the program terms and conditions completely or in part.  All interpretations of the membership terms and conditions shall be at the sole discretion of BBFPD Ambulance Membership.  Membership is non-transferable and non-refundable.  Persons who receive other government medical assistance benefits need not be members in order to have full coverage for services covered under these programs.  Any such membership constitutes a voluntary contribution only.  Violations of the terms of agreement may result in membership revocation, forfeiture of benefits associated with membership and an obligation to pay all balances in full.

Click here for the Ambulance Membership Application form.