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Who Pays?

Discussion in 'Firefighter/EMS Talk' started by AggiePhil, Apr 30, 2005.

  1. AggiePhil

    AggiePhil ΜΟΛΩΝ ΛΑΒΕ

    Nov 21, 2004
    When fire or EMS is called to a residence, do the people wind up paying for the services after the fact, or how does that work? Also, what if EMS has to transport them to the hospital and use supplies along the way? Does the patient get billed for that, or what? I've never known how this works but always wondered. Thanks! :)
  2. DaleGribble

    DaleGribble Sandwich!

    Mar 20, 2003
    Land of the toothless!
    When we first roll up into somebody's domicile the first thing we do is ask for $400.00 dollars up front before we do a thing! No money, no help and we're out the door before the patient can clutch his or her chest and elicit one final painful gasp!!!

    Ok, seriously...

    I'm not in charge of billing, so I only deal with the billing aspect for as long as it takes me to fill out the billing sheet, which is usually about five minutes.

    If the patient has private insurance, Medicaid or Medicare the bill goes to which ever provider the patient has.

    Now I'm not sure about the private insurance companies but Medicaid won't pay if an ambulance wasn't actually needed, which happens more than most people think!

    Under our billing system we don't bill for each individual item. If I put a patient on O2 I just check O2 on the billing sheet, I don't have the option of checking whether it was an NRB (the mask) or an NC (the nose thing) or how many liters of O2 the patient recieved. Same with IV's, we don't list which drip set and which size Jelco we use, although we do charge for each bag of fluid.

    We do charge for each individual drug though and there is also a per mile fee.

  3. AggiePhil

    AggiePhil ΜΟΛΩΝ ΛΑΒΕ

    Nov 21, 2004
    Wow, so they do pay individually. I thought that maybe taxes just covered it. I'm actually an EMT and never remember the medics I rode with saying anything about billing or doing anything that looked like billing forms. You know how the hospitals have those little barcode stickers on EVERY item that they take off and put on the billing sheet, so since the trucks didn't have that, I didn't know how it was done.

    How much does most stuff cost and what is billed if you just come out but don't transport?
  4. DaleGribble

    DaleGribble Sandwich!

    Mar 20, 2003
    Land of the toothless!
    I don't think we actually bill for no transports but we still fill out a billing sheet anyway since our billing sheet and refusal form is all rolled into one. I know for a fact we don't bill if the patient didn't request EMS. This usually happens at the scene of car wrecks. Somebody witnesses a wreck and calls for an ambulance. We show up, the person/people involved don't want any help, so they don't get billed.

    I don't know how much our equipment costs since I don't do any ordering of supplies either, I just use them.

    Not all patients pay. Some of them are so poor and there living conditions are so poor that you know the bill will never get paid. That's where your tax dollars supplement our budget and keep us up and running.

    This is just a wild guess but I think diesel and salaries are the biggest costs our service has!
  5. ClydeG19


    Oct 5, 2001
    It depends. Some places have a tax funded ambulance service and other places bill you/your insurer.
  6. hotpig

    hotpig IAFF Local 4766 CLM

    The grumpy old lady in the Office reads our reports and enters the billing charges into the computer. Several years ago we had to do it ourselves. The Hospital noticed that the EMT's were missing a lot of the charges. So now we do not have to do it.

    I think our average transport ie taxi runs is billed close to 450.00 Medicare will pay about 90.00 IF they deem that transport by Ambulance was justified. Medicaid pays about 65.00 if they deem it a good run. The rest of the bill is written off. Do not get impatient will waiting to collect the money. I have seen it take up to eight months to get paid.
  7. Tvov


    Sep 30, 2000
    We have a full-time, paid ambulance department in our town. When a call comes in, they bill as others have described. This billing just supplements their budget, the rest is paid for by the town (taxes).

    Volunteer fire department does not charge anything, all expense are paid for by the town budget. As of now, we don't respond to medical calls. If that changes, then we will have to bill for response, and probably go to a paid fire department.
  8. hotpig

    hotpig IAFF Local 4766 CLM

    FD will not get paid by most Insurance Companies if the Ambulance charges. Medicare and Medicaid will not either. If our ALS Ambulance intercept one of the volli BLS Ambulances we can not charge for our service. If we have a medivac heli pick the patient up at the scene we can not bill.
  9. AggiePhil

    AggiePhil ΜΟΛΩΝ ΛΑΒΕ

    Nov 21, 2004
    Who pays if the FD comes out to a fire call at your house?
  10. hotpig

    hotpig IAFF Local 4766 CLM

    Propery taxes cover unless you live in a area that contracts for service.
  11. Slinger646

    Slinger646 King of Sling

    Sep 5, 2004
    In the Mountains of VA
    100% Volunteer Rescue 100% Free.
  12. DepChief

    DepChief Get Tous's Rope

    Nov 27, 2004
    Outer Banks, NC
    It all depends on where you live and the level of service provided in your area. I work for a county ems system that is all career, we operate off the tax base which is supplemented by billing for calls. We only bill if we transport the patient. We also operate a med-evac helicopter and we cannot charge for helo transports because in the state of NC, you can only charge for flights if a flight nurse is on board. Since we fly with 2 flight medics and no nurse, we cannot charge.
    Fire depts do not charge for calls unless it is a private service. My parents live in Knox County, TN., just outside Knoxville and they pay around $300 a year subscription fee for fire protection to Rural Metro. If they dont pay the subscription fee, they would get charged $400.00 per hour for each fire truck that responds with a minimum of 3 trucks, $1200.00 per hour.
  13. TerraMedicX


    Sep 26, 2004
    Boulder, CO
    A lot of people have kinda hinted at it, but it REALLY depends on the individual system. EMS is an incredibly varried beast. Some systems use private ambulance company (like AMR or Rural Metro which are national corporations with branches in many areas). Because they are private companies and generally are payed little to nothing from taxes for their services, they usually charge (and usually quite a bit to make up for the LARGE proportion of runs that they can not collect on). To add another layer of complexity to this, some private ambulance companies are for profit while otheres are non-profit and this usually effects how much and what they will charge (as well as how much they pay their employees and the quality of equipment they have).
    There are other systems in which the fire department runs their own ambulances (Fire based EMS). These departments, generally, will not charge for their services because they are so well provided for from taxes in their district (this also varries depending on the area).
    Finally, there are what are called the public utility model systems. These are systems in which the ambulance company is separate from the fire department, but is tax funded (or sometimes subsidized) like the fire department. Some of these systems are also well covered by their tax funding and therefore do not charge for services (or don't charge residents of their tax district, although they may charge people who do not live there). Others are not able to gain quite the public popularity of fire departments and thus have not been able to pass mil levies or par with FD levies and so they charge to insurance companies but write off expenses above and beyond what insurance will pay.
    Like I said first, EMS changes depending on where you are, and I'm sure somewhere in the country there is a system that doesn't work like I just explained, or works like a combination of those. But the majority of the US follows one of these models.

    I'm not NEARLY as well versed on fire departments, but in general I would guess that most of them do not charge for their services if they are tax funded, but like some other people have said there are places where that's not the case.


    BTW: Just so you all know, we ALL pay for EMS runs on people who have no insurance/are homeless/simply don't pay the bill. THAT is the real reason insurance costs and ER/ambulance bills are so high!
  14. Where im from we charge a flat rate for just rolling out the door. If we transport, charge by the mile on top of the flat rate. Then we charge for equipment used. The only thing on the fire side we charge for is vehicle extrication which is part of the EMS bill. To give an idea our charges are as follows:
    BLS run - $375 + $4.75 per mile to hospital
    ALS run - $525 + $6.25 " "
    02 used - $30 flat rate
    any drug adminiatered - $75 each
    defib / cardiac monitoring - $200
    other ALS protocol - $125 each
    vehicle extrication - additional $500
    We bill insurance which picks up the tab nearly 98% of the time. If not, you get the bill. Were usually pretty cool ta work things out with though. ;)
  15. obxprnstar

    obxprnstar Goth Lover

    Jan 8, 2003
    Zombie Patrol
    Emergency medical services
    Basic life support (BLS) non-emergency $ 175.00
    Basic life support (BLS) non-emergency – long haul 176.00
    Basic life support (BLS) emergency 281.00
    Basic life support (BLS) emergency – long haul 282.00
    Advanced life support (ALS) non-emergency 210.00
    Advanced life support (ALS) non-emergency – long haul 211.00
    Advanced life support (ALS) emergency 333.00
    Advanced life support (ALS) emergency – long haul 334.00
    Critical care (CC) critical care 483.00

    Milage is 8.94 per loaded mile.