Published in the Asbury Park Press 5/06/04

An area legislator is calling on the state Department of Health and Senior Services to investigate the billing practices of MONOC, the familiar name of the Monmouth Ocean Hospital Services Corp.

"There is clearly a problem when our residents are billed more by the paramedic service that takes them to the hospital than by the hospital itself for emergency medical services," said Assemblyman James W. Holzapfel, R-Ocean. "It is time for the state to examine MONOC's billing practices to ensure that area residents are not overcharged for this service."

Holzapfel said in a prepared release yesterday that his office has been contacted by residents who cannot persuade their insurance carriers to cover more than a portion of large bills from MONOC.

"To make matters worse, MONOC unabashedly files lawsuits against those whose bills are not paid in full," he said. "In fact, they currently have more than 600 lawsuits open against Monmouth and Ocean residents."

A spokesman for MONOC said people and politicians blame the company because they do not understand how emergency transportation works in New Jersey.

"Eighty-five percent of our revenue goes toward maintaining readiness," said John DeFillippo, MONOC public information officer. "We would love not to charge people, to have subsidies pay. But that's not the way it works in New Jersey."

MONOC is a nonprofit consortium of 10 acute-care hospitals in Monmouth, Ocean and Atlantic counties that provides advanced life support in emergency transportation situations in a 1,500-square-mile region.

Unlike other mobile intensive-care units, MONOC is not based out of any one hospital. DeFillippo said this difference causes MONOC's charges to be slightly higher than other such services.

"When not sufficiently reimbursed by insurers or patients, hospitals can make up the shortfall elsewhere. We cannot," DeFillippo said.

DeFillippo also said the advanced life-support services are operated by paramedics who are more extensively trained and permitted to perform more emergency duties than the emergency medical technicians, or EMTs, who accompany the paid or volunteer ambulances that provide basic life support.

Paramedics are permitted to administer certain medications and start certain life-saving procedures that EMTs are not allowed to perform. Paramedics are also in direct contact with emergency room physicians during the trip to the hospital.

"That (emergency room) physician is also paid from the money MONOC collects," DeFillippo said.

DeFillippo said people sometimes criticize MONOC for showing up at an emergency, rather than only a local ambulance.

"They don't understand that when they call 9-1-1, the dispatcher makes a judgment on the seriousness of the emergency and, if it appears to require ALS, then we get the call as well as a BLS team," he said.

Ellen Wall of Middletown, however, has little sympathy for MONOC.

"MONOC would not accept the amount of money my insurer said they deserved," said Wall, who was assisted by MONOC when suffering a breathing disorder at her home in March 2002. "My insurer, Horizon Blue Cross-Blue Shield, finally paid $1,400. But MONOC still wanted another $211."

Wall paid the $211 when MONOC threatened to take her to court.

"I could not afford to damage my credit rating," she said. "But I have had an emergency at my house since. When MONOC arrived, I sent them away. I waited for the local (emergency medical services)."

DeFillippo said the company is within its rights to pursue unpaid bills.

State Sen. Joseph Vitale, D-Middlesex, spurred the Department of Health and Senior Services to investigate MONOC's billing practices last year. Vitale said his probe revealed problems plaguing the state's entire emergency transportation system.

"All the ambulance services, both BLS and ALS, are not suf-ficiently reimbursed," Vitale said. "Insurers base their reimbursement rates on what Medicare pays, and Medicare has been lowering its reimburse-ments over the last few years."

Vitale said the problem was to determine "how much is too much." It may take legislation to established a standard schedule for emergency transport charges, he said.

The state Health Department may also be leaning toward a legislative solution.

State Health Commissioner Clifton R. Lacy last year named a blue-ribbon panel to study the fees. One of the panel's recommendations is that the commissioner should support legislation to subsidize some of the costs incurred by providing advanced life support.

Marilyn Riley, Health Department spokeswoman, noted that the department "does not have regulatory authority over the fee structure or billing practices of emergency medical services providers," but would like to discuss the issue with Holzapfel.

Vitale also would like to talk to Holzapfel because, he said, "it's a bipartisan issue that needs work."