2009 008 Ordinance - Laserfiche WebLink

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Unless the waiver of a responsible party or Resident financial obligation would result in a Client service not being covered by insurance or a benefit plan, Life Force shall not bill and attempt collections for individuals located in C1ienYs jurisdiction who substantiate their residency status based on reasonable criteria established by Client ("Residents"). Life Force will bill and attempt collections from Non-Residents for applicable co-pays and deductibles unless covered by secondary insurance. PLEASE ATTACH COPY OF ORDINANCE/LEGISLATION. Definition of Resident Client will be responsible for determining the Resident and Non Resident status before submitting the trip to Life Force, obtaining documentation to substantiate residency status, and selecting the informational statements received by Residents. In some cases, the information obtained from the receiving hospital may be used by Life Force to determine the patient's residency. Client will include the following individuals in its definition of Resident status: (PLEASE INITIAL ALL APPLICABLE) Individuals with a permanent legal residence (residence of record) within the jurisdiction of Client. The residency category of a minor is determined by the residency of their parent or legal guardian. Individuals employed by tax-paying Employers within the jurisdiction of Client. For mutual aid calls, Client elects to have Life Force do one of the following: treat the patient as a Non-resident. follow the billing procedures established by the community in which the person transported resides as-instructed by Client on the trip report. Billing of Residents Pursuant to Section 1(C)(4), Client directs Life Force to handle Resident "insurance only" billing and collections as follows: a. Generallv. Life Force will send Residents a request for insurance letter indicating that Life Force will submit the claim to the Resident's Payor and that the Resident need NOT directly pay the submitted amount. Life Force will accept the covered reimbursement from the Payor for the fee charged as "Paid in Full" regardless of the Resident's outstanding co-pay and deductible. If the Resident does not have coverage or the Payor does not pay the invoiced amount, Life Force will submit the information to the Client for further instruction. If the Resident does not respond to the communication and collection attempts from Life Force, the Resident will be considered non-insured and the account will be adjusted. Life Force is authorized to 22068/513664-1 CUSTOMER NAME: DATE: