ems billing

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No, if you only need the medical record you may submit your request to admin@wcesd3.net by fax at 830-542-6595 or by mail at 11984 US Hwy 87 W, La Vernia, TX 78121.  If you need billing records you will need to submit your request to Specialized Billing & Collections Systems of Texas.

We do our very best to work with all our patients.  We do have a charity care policy in place to help those that are uninsured and underinsured.  We ask that you contact the billing office and explain your situation and ask for a discounted offering or charity care.  If you are still having difficulties after that please feel free to reach out to us at our admin offices and we will get it worked out.  We are here to serve the community and worrying about a medical bill or not wanting to call an ambulance because of a bill is not what we want.   

Yes, our 3rd party biller is located in Houston.  When you receive the bill, it will have our agency name and show our address as  PO Box 691916, Houston, TX 77269. 

This can be for a number of reasons.  Was the claim at the beginning of the year when deductibles and max out of pockets reset, if so this would be the main reason.  This also means your EMS claim ate up most or all of your out of pocket max (depending on your policy amount), therefore the remainder of the year you shouldn't pay any or much out of pocket for any medical going forward.  EMS is considered out of network for most insurance companies.    Another reason is most insurance companies only pay a portion of an approve procedure/treatment.  When we receive the denial we have to submit an appeal and this takes some time to process.  If you would like for us to look into it further, please contact our offices.

No, we DO NOT utilize a Collection Agency and we DO NOT report to any of the credit bureaus.

Wilson County Emergency Services District No. 3 rates are at the industry standard.  A lot goes into determining rates such as cost of medical supplies, equipment, ambulances and personnel.  With the inflation everyone is experiencing, the EMS industry is no different and not exempt.   

No, depending on your policy type, your deductible and out of pocket maximums we may not see any payment from the insurance company.  Take a commercial insurance policy, if you have a 70/30 plan for example, lets say the bill was for a $1000.  This does not mean insurance will pay $700 and you $300.   After the insurance company evaluates the claim, allows for "contractual allowances" then approve or deny certain treatments and procedures and then they determine that only $300 of this claim is approved, the insurance will then pay $210 and you would be responsible for the remaining $90.  When we talk about Medicare and Medicaid, there rules are much different and pay much less.  If you take Medicare for example, and the claim total is again $1000, after they review the claim and approve or deny certain treatments/procedures they have a max set amount they will pay per item.  So even if the amount for this one item was $100, they may only approve a max of $20 to be paid for that line item if approved.  So on average overall Medicare/Medicare will pay no more than 20% of an approved claim.      

The No Surprises Act (NSA) ended balance billing for out-of-network services at the federal level for health care services but delayed addressing ground ambulance, opting instead for further study. Congress recognized that it was critical for EMS agencies to have the revenue necessary to fund 911 services, and the NSA directed a committee to determine the best way for EMS agencies to be paid for their vital services.  Due to Congress’ delay of solving the out-of-network billing issue for EMS agencies, the 2023 Texas Legislature acted by passing SB 2476 (88-R). The

Texas law created important patient protections by ending balance billing for ground EMS services. It also required health plans to follow a fair reimbursement methodology that promotes EMS sustainability, particularly in struggling rural communities.  Under state law, patients who have health plans that are regulated by the Texas Department of Insurance do not have to worry about an unexpected medical bill following a ground ambulance service.

The 2023 law featured a sunset due to the expectation that Congress would finalize a decision as to how the NSA would address out-of-network ground ambulance billing as it pertains to ERISA plans. The goal was to harmonize the state solution to the federal law, thereby

ensuring a clear, single approach for all Texas patients, health plans and EMS agencies.

However, Congress has yet to address the ground ambulance exception found in the NSA, and it is now critical for the 2025 Texas Legislature to pass SB 916.