Orange Cross Ambulance, Inc. is a 501(c)(3) non-profit corporation based in Sheboygan, WI, and contracted by Sheboygan County to provide 911 emergency medical services to the citizens and guests of our community. As a 501(c)(3) non-profit corporation, all of Orange Cross' earnings must be reinvested into the mission of the organization in the form of the equipment, facilities, and personnel that support it. No private individuals, shareholders, or entities profit from the organization's earnings.

In addition to providing 911 emergency service, Orange Cross Ambulance also supports several regional hospitals by providing basic life support all the way to critical care interfacility transport service, conveying patients to regional specialty centers for advanced care.

Orange Cross Ambulance, like many EMS agencies throughout the United States, is not in-network with any commercial health insurance carrier. As such, Orange Cross Ambulance does not accept any adjustments from commercial health insurance carriers. “Adjustments” are defined as reduced payments to a healthcare provider from an insurance company as the result of contract agreements.

As a recipient of Medicare and Medicaid payments, Orange Cross is required by state and federal law to accept all required CMS adjustments.

Orange Cross Ambulance is committed to price transparency and patient advocacy, and as such, has created this resource page to help assist you in understanding and navigating the complex landscape of US healthcare. We encourage you to review the information under each header below.

Commercial health insurance plans typically cover a range of medical services, including doctor visits, hospital stays, and prescription drugs. The amount of coverage provided by a plan will depend on the specific policy and the premiums paid. Some plans may also provide coverage for preventive care services such as immunizations, routine check-ups, and cancer screenings.

Commercial health insurance plans often have a deductible, which is the amount that the policyholder must pay out-of-pocket before the insurance company begins covering the cost of medical services. After the deductible is met, the policyholder typically pays a copayment or coinsurance for each healthcare service received.

In addition to deductibles, commercial health insurance plans often have limits on the amount of coverage provided for certain services. For example, a plan may have a maximum limit on the amount of coverage for prescription drugs or hospital stays. These limits are often referred to as "out-of-pocket maximums."

Commercial health insurance plans may also have networks of healthcare providers that policyholders can use. These networks include doctors, hospitals, and other medical providers that have agreements with the insurance company to provide services at a discounted rate. Going outside of the network may result in higher costs for the policyholder.

Medicare is a federal health insurance program that provides coverage to individuals aged 65 and over, as well as some individuals with disabilities and those with end-stage renal disease. Medicare coverage is designed to help beneficiaries access necessary medical services and treatments, while also providing some financial protection against high healthcare costs.

There are several parts of Medicare coverage, each of which covers different types of healthcare services:

• Medicare Part A covers inpatient hospital care, skilled nursing facility care, and hospice care.

• Medicare Part B covers outpatient medical services, such as doctor visits, diagnostic tests, and preventive care.

• Medicare Part C, also known as Medicare Advantage, is an alternative to traditional Medicare that allows beneficiaries to receive their healthcare benefits through a private insurance company.

• Medicare Part D provides prescription drug coverage to beneficiaries.

In order to be eligible for Medicare coverage, individuals must meet certain requirements, such as being 65 years of age or older and having paid into the Medicare system through payroll taxes for at least 10 years. Some individuals with disabilities and those with end-stage renal disease may also be eligible for Medicare coverage.

Medicare coverage typically works by reimbursing healthcare providers for covered services and treatments. Beneficiaries are responsible for paying certain out-of-pocket costs, such as deductibles and copayments. However, there are some programs available to help beneficiaries with limited income and resources cover these costs.

Overall, Medicare coverage provides a safety net for older Americans and individuals with disabilities, helping them access necessary healthcare services and treatments while also providing some financial protection against high healthcare costs.

Medicaid is a joint federal and state health insurance program that provides coverage to individuals with low income and limited resources. Medicaid is designed to help beneficiaries access necessary medical services and treatments, while also providing some financial protection against high healthcare costs.

Each state administers its own Medicaid program, following certain federal guidelines, and sets its own eligibility criteria, benefits, and payment rates. However, all Medicaid programs must cover certain basic services, such as inpatient and outpatient hospital care, physician services, laboratory and radiology services, and home health care.

In order to be eligible for Medicaid coverage, individuals must meet certain income and asset criteria set by their state. Eligibility requirements vary by state, but in general, individuals must have income at or below 138% of the federal poverty level and meet other financial requirements. Additionally, certain groups, such as children, pregnant women, and individuals with disabilities, may be eligible for Medicaid coverage regardless of income.

Medicaid coverage typically works by reimbursing healthcare providers for covered services and treatments. Beneficiaries are responsible for paying certain out-of-pocket costs, such as copayments and deductibles. However, Medicaid also provides some additional benefits, such as transportation to medical appointments, vision and dental services, and prescription drug coverage.

Overall, Medicaid coverage provides a safety net for individuals with low income and limited resources, helping them access necessary healthcare services and treatments while also providing some financial protection against high healthcare costs.

VA healthcare coverage is a government-provided health benefit program for eligible veterans and their dependents. It is operated by the U.S. Department of Veterans Affairs (VA) and offers a range of medical services and treatments to eligible individuals.

To be eligible for VA healthcare coverage, a veteran must have served in the active military and received an honorable discharge or general discharge under honorable conditions. There are also other eligibility criteria, such as income and service-connected disability status, that may impact a veteran's ability to access VA healthcare services.

Once a veteran is determined to be eligible for VA healthcare coverage, they are assigned to a primary care provider within the VA system. This provider is responsible for coordinating the veteran's medical care and ensuring they receive necessary services and treatments.

VA healthcare coverage includes a range of medical services, including primary care, mental health services, specialty care, and prescription medications. Veterans can receive care at VA medical facilities or through VA community care providers, depending on their needs and preferences.

In some cases, veterans may be required to pay copayments for certain services, based on their income level and service-connected disability status. However, many veterans may be eligible for no-cost care through the VA.

Overall, VA healthcare coverage provides eligible veterans with access to necessary medical services and treatments. The program aims to ensure that veterans receive high-quality, coordinated care that meets their unique healthcare needs.

• Question: My insurance company or Explanation of Benefits (EOB) stated I didn’t owe anything after they paid, why am I still getting a bill?

  • Answer: Orange Cross has standard charges for service and has billed you as an out-of-network provider. Your insurance company has opted not to pay the amount you actually owe and has instead covered covered a portion of the cost, defering the remaining amount to you as the patient.

• Question: Can I setup a payment plan?

• Question: I received a payment in the form of a check from my insurance carrier. What should I do ?

• Question: