Charging For Use of EMS

[antiquefirelt 994]

How many states have a "Bill the spiller" law that allows for haz-mat clean-ups to be biller to the spiller?  We have one here in NJ.

I view ALS/BLS as a similiar situation, high overhead that should be absorbed by the user.  Check your health insurance, most billing is done within the max allowed and provided for by your insurance company.  We have a hospital based BLS service from 6a to 6p that costs taxpayers ZERO unless they need assistance.

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I'm pretty certain "Bill the Spiller" is Federally mandated, if you choose not too, you're losing money. The issue would be who has the right to bill. If you recieve all your equipment, consumables and payroll from the State, then they probably have to send the bill vs. the local dept. that is funded locally. Our Haz-Mat team bills the spiller for every run regardless of where it happens. If we respond, we bill, even outside our municipal boundries.

As for ALS/BLS and insurance billing: If your service bills Medicare then all the rules are already made for you: what can be billed for, proper documentation, maximum amounts allowed (by region) for ALS, BLS and loaded miles. Medicare also makes you meet the federal ethics or fair business practices rules. For example it says that you may not purchase any items from anyone who works for your service or who's family works for your service. All employees must be screened to ensure they are not on the Fed's list of bad people, such as those who have defaulted on a student loan. Their is a database that all employee's and potential employees names must be checked with. If you have or hire someone on this list, you can lose all Medicare funds you were paid during their employment. And Medicare doesn't screw around, they immeidately pull all your funds and make you prove to them you're in the right before restoring any! It is for these reasons our municpal EMS dept. contracts out billing as there are too many rules to stay abreast of and the consequence of failing to do it right can shut you down.

[helicopper 1,050]

bvfdjc316 You made a stance brother.  Don't back down now...some on here can smell blood 6 miles away and you may get swarmed.  Stick to your guns, use your facts and state opinion when it is just that.  This is what this site is for.  I don't agree with you and your stance, but I respect it, and you're really not doing all a bad job keeping your argument strong.  Now with that, lol:

Really?  Have you looked into this?  Have you talked to any Canadians whom need surgery.  There are stories of canadians waiting months and years in order to receive the surgery they need...like gall bladders and ortho procedures, even after injuries.  So the concept may be right, but the system has serious flaws.

I am a veteran and swore to defend the document those words are spoken in.  However it says you have the right to that.  Ever think that "life, liberty and pursuit of hapiness" is why EMS exists.  When that pursuit causes illness and injury.  Facts are there dude, nothing you do is for free, taxes are the price of freedom.  How come you have no problem paying for those whom do not contribute to the assistance they receive, like medicaid and welfare?  If you don't live on your own you won't realize this. 

Education allows you to gain a hold to achieve liberty and pursuit of hapiness.  Is that free?  Nope, you own property you pay school district taxes on that property.  Hate to break it to you, but your argument based on this quote is weak.  Also have you ever heard the term "you get what you pay for?"

Why would we need any type of insurance to recoup from injury, accident, disaster if the world was as you say it should be.  It can't that is why.

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Maybe some of our scholarly brothers can enlighten us but I'm pretty sure that the founding fathers reference to "life" in the Declaration of Independence wasn't referring to the provision of EMS or even healthcare but rather the freedom from persecution by the Government. Was there even any organized healthcare system in the 18th century?

As ALS said, sure our system if flawed but it's still way better than most of the alternatives! I once vacationed on an island in the Caribbean that didn't have a defibrillator - anywhere on the island of several thousand people. The "hospital" on the island didn't even have one! We have defibrillators EVERYWHERE. Just as one simple example.

And, just so someone else gets their chops busted a little - Hey ALS, didn't you swear to support and defend the Constitution? Life, liberty and the pursuit of happy hour is in the Declaration of Independence. Sorry, smelled blood and wanted to swarm.

I think tax subsidies for emergency services are important to insure that the system exists but the taxes should be offset by user fees or charges so the taxpayer doesn't suffer.

BVFDJC316, don't get discouraged because people disagreed with you - that's one of the reasons I joined EMTBravo - to exchange ideas, discuss thoughts, learn from other members, and stay abreast of what's going on around me. You're doing the same thing and there's nothing wrong with that.

Edited for my insanity!

[Guest alsfirefighter]

You got me Chris. Diarrhea of the mouth (fingers) constipation of the brain. "We hold these truths to be self evident, that all men are created equal, that they are endowed by their creator with certain unalienable rights, that among these are life, liberty and the pursuit of hapiness." I did think of that earlier but it just didn't register...not enough coffee in the gut. Wouldn't be the first time you've smelled blood around me. lol.

I believe the provision of reimbursement for hazmat for emergency services falls under Sara Title III federal legislation if I remember correctly.

SARA= Superfund Amendments and Reauthorization Act.

There are ways to better the EMS system financially. Fire Department's in NY have the 2% requirement of fire insurance companies. Why isn't there a program like this for EMS? Because care insurance rates are more noticible then your fire insurance and again many agencies are billing now to the insurance for MVA transports. Why not add a fee to drivers licenses and DMV transactions to supplement state funding, or locally add an additional fee to all permits for new construction and so on. There are ways we have to speak up.

[nycemt728 49]

Wow, what a discussion. First off, I think it would be wonderful if agencies didn't charge for their services. I work for two volunteer agencies (and one paid) where patients are not charged for services rendered. The relief and gratitude on people's faces when I tell them " No, we're the vollies, we don't charge" is wonderful. However, this is a dying reality. Even many volunteer squads, some supported by tax dollars, others not, have begun to bill. Like one poster said, it may be a soft bill where it doesn't go to collection agencies, however the norm appears to be for patients to expect to be charged for services they recieve. While not charging does wonders for our patients, it makes sustainging our services a challenge.

FDNY bills, one also has to remember the amt of bullshit a large munipal agency like this gets. W/ no disrespect to people's problems, some people call 911 for total bull and can easily take cabs but FDNY is legally bound to take them. W/o charging patients like these, the system would be overburdened and bankrupt. Having not lived anywhere else other than NY, I was surprised to hear that some municpalities don't charge, can anyone provide an example??

I don't know if there's a solution to this problem. I realize not everyone can pay for ambulances. I think a big help would be to attempt to keep the cost of a single trip down, perhaps by billing by call type or services rendered, not just simply BLS/ALS or mileage. Additionally, I think we need to help preserve those agencies that do not bill just as much as we do the ones that bill, b/c they help take presssure off other agencies and they provide an alternative to those who cannot pay for the lifesaving services of an ambulance.

On another note b/c this topic went REALLY far, the Canadian health care system is not as perfect as it seem. Yes they all have some basic rights that are included. However, other things that are easy for Americans are the opposite there. If I recall, some people simply get dentures b/c the dentisty is so expensive and overcrowded.

Edited January 25, 2007 by nycemt728

[Guest]

Antique/ALS you are correct, it does originate from federal.

[ltjay157 10]

I've talked to insurance agents in CT for my dept because we are working on insurance billing for fire calls. We mostly were going to bill for MVA's, pumpouts, structure fires etc. because sometimes our equipment gets broken or damaged during theses operations. We're not making a profit off of this because the money will be going strictly to replacing the items used, broken, damaged. The insurance agents were surprised when they found out that we didn't already bill for these services. They told us that when they write up your home/car insurance policy, it's included. So I don't feel it's unethical to bill for services because we'll come whether you can pay or not. It's not like doctors who may refuse to treat you because of the inebility to pay? On a side note, I find it not right that an illegal immigrant can recieve free healthcare at the hospital ER because he can't pay, but an American has to pay. Guess who foots the illegal immigrants tab? WE the AMERICAN PEOPLE do. So tell me if that's fair?

[antiquefirelt 994]

I've talked to insurance agents in CT for my dept because we are working on insurance billing for fire calls. We mostly were going to bill for MVA's, pumpouts, structure fires etc. because sometimes our equipment gets broken or damaged during theses operations. We're not making a profit off of this because the money will be going strictly to replacing the items used, broken, damaged. The insurance agents were surprised when they found out that we didn't already bill for these services. They told us that when they write up your home/car insurance policy, it's included. So I don't feel it's unethical to bill for services because we'll come whether you can pay or not. It's not like doctors who may refuse to treat you because of the inebility to pay? On a side note, I find it not right that an illegal immigrant can recieve free healthcare at the hospital ER because he can't pay, but an American has to pay. Guess who foots the illegal immigrants tab? WE the AMERICAN PEOPLE do. So tell me if that's fair?

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The only thing that might look unethical would be to bill for services when an insurance company is involved then not bill if the homeowner doesn't have insurance? This is the issue with many smaller towns that bill out of town residents but not residents. Of course this is a clear Medicare violation but not clear with other billable services.

Our dept. is just beginning to bill other services for ALS responses and EMS mutual aid. This is in response to many services not being adequately funded to maintain paramedics or enough crew to staff a rig. At least one of the services is wholly volunteer and does not bill at all. They will be forced to start billing becuase they cannot afford to pay us $200 a whack for paramedic responses. Of course they have not had the funds to send their people to paramedic school or to retain paramedics in the their town either. Its not a good feeling for us, but our taxpayers cannot subsidize EMS throughout our county.