A Predatory Ambulance Fee?

I just read an article on JEMS.com that's got me concerned. Since I'm a blogger, I thought that I'd share it with you. It's kind of what I do.

The article concerns a city in Illinois that wants a fee increase for their fire-based ambulance service. At first it looked like just another city wanting to increase its charges for providing transports. That’s hardly newsworthy for ambulance services in Illinois these days as they’re mostly all trying to recoup more expenses.

However, read the story and try and see if you see what I saw: “Ambulance Fees May Jump 25% in Elgin”.

It’s way at the bottom. Did you see it?

Here’s what sets me off:

“A new charge for refusing advanced life support upon the arrival of emergency responders also is proposed. For nonresidents, the charge would be $400 each time. For residents, the charge would be $300 after the third occurrence in a 12-month period.”

A new charge for refusals? According to this if you’re not a resident of the city, have a minor fender bender that someone calls an ambulance for, and sign a refusal of care form, you’re going to get a $400 bill. What if it’s not auto-related and you slip and fall on some ice and someone calls? Is that worth $400 if you’re not hurt and an ambulance shows up? This sounds to me like every time someone plays "Cell phone hero" and calls 911 for something where nobody is hurt the service is going to get paid. Sure, it'd be nice for the ambulance service… but I don't think it's fair to the poor people getting the bill.

What about if you see an ambulance down at the local coffee shop and they ask you how you’re feeling… is that worth $400 too if they ask you for your autograph?

This is not fair.

I can see what they’re probably trying to do. They’re probably trying to crack down on their system abusers by making them financially responsible. I support a lot of those efforts if they’re well thought out. This one is not. This isn't neccesarily a case where someone is getting something for free and should be charged for it. According to the article, this fee would apply to all refusals of care regardless of whether or not any services were provided. 

I am a fan of treating and releasing patients in certain circumstances and I've written a few published articles on the topic, like this one regarding treatment coverage for hypoglycemic diabetics we sweeten up then sign off, and also this one that covers a procedure that I call the "Enhanced Refusal". I agree that both of those circumstances should be covered by a fee. I believe that if EMS provides a necessary service to someone that we should be able to recoup our costs and make it worth our time. This is not one of those cases.

Think of it this way. This is akin to you telling your neighbor you think your air conditioner is on the fritz in a casual conversation. Your neighbor, being a helpful person calls a heating and air conditioning contractor without your knowledge.  The contractor shows up at your house to your surprise, and when you tell him your air conditioner is just fine and you don't need any repairs he charges you $400 for his time.

You'd be outraged and wouldn't pay it.

Of course I know that this most probably is not the line staff proposing this change. This one has all of the hallmarks of some uninformed bureaucrat all over it.

I will not be signing one of that ambulance service’s refusal forms. I suggest you don’t either.

Is anyone else doing this?

  • Agreed, CK. I’ve told my family for years that the only time they should even consider signing a refusal is if they personally called for the ambulance and then changed their mind. No matter what the crew says, you never HAVE TO sign anything.

    What’s the legality of charging for a service which I did not request, do not want, and did not accept? Their probably banking on the fact that most people won’t take the time and $$ to fight it.

    • Joe

      Just got into a heated debate with one of my supervisors over this exact same issue, in which I gave the same scenario word for word.  His response was, and I quote, “we will just get the information from PD and send the bill any way.”  Then went on to say, “Think about it, would it be worth their time and $$ to actually fight this in court?” and finished with “It’s a sign of the times.  Keep in mind that the service I work for now just started doing this and it is a $100 for each refusal and $100 for a lift assist.   Unfortunately it seems that it is not about patient care anymore as it is the almighty $$$

  • I agree, completely outrageous.. If I knew of the fee I’d simply refuse to sign the AMA form. I understand the growing problem of 911 abuse but that can be taken of care through the legal system, not by screwing innocent people who may not have even requested 911 in the first place.

  • Clayton

    I agree with the fee concept. Why do we give away a servie? Is there no value to the risks we go thru every time we repond on a 911 call? I work for a 3rd service and we live entirely on our transport dollars. With the reduction of collections in todays market, EMS will need to come up with new ways to keep their head above water, or everybody will suffer when we close our doors…..

    • Anonymous

      That is one of the things that is wrong with this country. Thoughts like yours. Whatever happened to the ideal this country was founded on called Volunteering?? I agree there are money issues, but no way would I consider paying for a service I did not receive. Your way of thinking says maybe we should pay for a meal at a restaurant that we didn’t eat just because we walked by the place. Think again. There has to be a better answer.

      • Clayton

        Yes you should pay for a meal if you get the service. If you sit at the table, the meal is cooked, you are served, and you choose not to use it. What about the rest of the community who will loose the service if we do not come up with new ways to generate revenue? I am a volunteer at my local Dept. and I can tell you one thing, there are very few volunteers today due to the training requirments. If we do not come up with new ways, on our own, to fix the money issues we will go away. I work in an area who has lost their school due to voting it out. I want to protect everybody. Everybody knows the Government will not take care of EMS, even though we run 90% of 911 calls……We need to be self sufficent.

        • Anonymous

          I think you misunderstood me on the meals part. If I walk past a restaurant and do not walk in their door do I have to pay for a meal just for walking by? I am a retired EMT and got frustrated too with what we called the “suitcase calls” but they were still people in our community asking for help. I agree on the low amt. of volunteers and it is because of the training time required not to mention so many people work more than one job and live in two earner families. Enough can’t be raised just on local contracts. Our country has lost so much of the values that made us great. I am 62 years old and have seen a change that makes my heart hurt with sadness. I think the only way to get back to those values is for the entire world economy to collapse sending us all back to “0” and we have to start over and start with the good old fashioned barter system causing people to stop and think about each other first.

  • So according to you, Clayton, if I fall on the sidewalk and someone sees it and calls 911 and I refuse transport because I’m not injured I should pay your ambulance service for coming out??!!  How about charging the person who called 911 before checking to see if I’m ok?  What, can’t find that person?

    I’m all for finding ways of curtailing “frequent flyers” but charging someone some astronomical fee for refusing the service is wrong, ESPECIALLY when that person didn’t even request the service in the first place!

  • The fact is that when EMS responds to a call, expenses are incurred. Those expenses need to be recouped, end of story. The problem is magnified when you include private agencies that rely solely on billing for their income. I do agree, however, with your point that the fee for refusal of service is unfair, as individuals have no control over who requests EMS to respond and EMS generally has no choice but to answer every call for help, even if only to limit liability. The real issue is that EMS has no direct Federal level representation and as such, will ALWAYS be underfunded. I was involved many years ago with a grassroots movement to establish the United States EMS Administration as set in motion by Don Walsh, PhD but this died without much accomplished. The trickle-down of funding through the US Fire Administration leaves little left once each “helping hand” has taken a piece. As it stands currently, the agency for which I work is only paid when we transport a patient. I’m sure there are many that operate similarly. That means that every refusal of transport once treatment is rendered and every pronounced arrest left on scene after resuscitative efforts have been exhausted, incur a financial burden upon the responding agency that cannot be recovered. There needs to be progressive movement in the repayment of those expenses and charging those who request services but refuse transportation is the next logical step. However, It does need to be applied reasonably. The fender-bender where everyone denies injury must be handled differently than the indifferent diabetic who is chronically given a D50% fix yet refuses any further treatment or transportation once they’re alert & oriented enough to do so.

  • Pascal

    These kinds of charges are usually being put into place
    for 1) The habitual abuser, 2) The trauma patient you expend resources on and
    then fly in via air, 3) The patient you treat like the diabetic who has a true
    emergency that you treat and then they refuse to go to the hospital after you
    fix the problem.  These types of calls
    drain the coffers of the service.  The
    push should be to reform the way insurance reimburses.  As of now you can expend up to $1000.00 worth
    of services treating a trauma patient so that the helicopter can fly off into the
    sunset and bill insurance for the service.  I do believe there is a $20.00 reimbursment if you transport to the helicopter. 
    The diabetic patient will take up to $200 – $300 worth of resources and
    you can’t collect because you can only bill if you transport.  I don’t think that the jest of this
    legislation is to bilk the citizens.  It
    should be worded differently if the citizens are getting this meaning from it.  This kind of thing can greatly hurt your relationship with the public.

  • Cm Tomory

    I would think somehow that would be illegal to charge someone if they didn’t call ems to begin with and then signed a refusal. As far as the diabetic refusals we charge the patient directly for supplies used hence a diabetic refusal with treatment.

  • eyeofnate

    After reading CK’s article, as well as the actual story regarding Elgin EMS’ fees, I believe CK may have misunderstood the intent of the refusal charge.  In the story, Elgin EMS recognizes, “…Ambulance fees differ by treatment from basic life support to two levels of advanced life support…”.  The refusal fee appears to be assessed on patients receiving, or requiring, Advance Life Support (ALS) care.  The story did not indicate any fee assesed to patients recieving, or requiring, BLS care who choose not to transported, or to any non-patient as a result of arriving on a location.

    As a supervisor with a service in Texas, we are required, as I believe most services are, to obtain the patients consent prior to performing any ALS skills.  The story, as it appears to me, is actually suggesting a fee is to be charge when the pt has agreed, or is recommended by Medical Director protocal, to recieve ALS care and then chooses not to be transported to an ER.  If that is the case, then yes, the services we provide as Medical Professionals are worth $400. 

  • If we are called, evaluate or treat a person with a complaint and they refuse transport, then there should be a fee. I dont know about $400. However I have worked places that charged $50 for a RMA and up to $800 for an ALS RMA.

    The problem I have is when EMS is called to a scene by a cell phone hero or other entity and the person has no complaint. Yet the crew is mandated by their agency to obtain an RMA for a CYA reason. To me, no complaints and A&Ox4 means no patient. So at that point forcing a refusal on that person and then charging them for it is wrong.

  • I’m going to agree with EyeofNate… I read this as a bill for a refusal after ALS care is provided, not a fee for every EMS encounter.

    The biggest case being the hypoglycemic diabetic that EMS “fixes”. There are plenty of others. I’m sorry – more places do this, and eventually Medicare might realize we do more than drive from Point “A” to Point “B”.

  • Pingback: Coming Soon – The Law of Unintended Consequences meets the fire service | Life Under the Lights()