Charging For Use of EMS

[SRS131EMTFF 471]

Look at this fire department in Reading, PA

According to the Reading PA website, this department charges the residents for the use of the EMS system and every possible aspect associated with it.

"Rate Structure

Category Charge

Advanced Life Support

ALS Level 2 (base rate) $800.00

ALS Level 1 (base rate) $750.00

Mileage $7.00 (per loaded mile)

Oxygen $60.00

Cardiac Monitor $95.00

Basic Life Support

BLS Emergency (base rate) $600.00

BLS Non-Emergency (base rate) $500.00

Mileage $7.00 (per loaded mile)

Oxygen $60.00"

http://www.readingpafire.com/emsservice.htm

Does any one know of any EMS agency supported by the government charging the residents for the use of their own EMS service?

I believe that it is utterly unethical for an agency to charge its users for the use of the that agency especially when that agency is supported by the government.

Does any one else feel that this idea is ridiculous charging the users is insane?

[Guest]

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Sorry for the post above this I hit enter by accident and the message posted. Across the country many EMS systems that are paid for with public funds bill for their services. They are 3rd service, FD based or police based. Many cities cannot afford to raise taxes enough to cover all costs associated with running an EMS system, especially when in the bigger urban cities the ambulance can be used for a taxi ride. Many places where a private company is used for the EMS service for the town. The bill for service but they also receive some funding from the town or city. Due to medicare and insurance rules and regulations all costs are not covered by the bill. So Public funds are being used to support those services as well. AS for adding the costs of equipment use, mileage etc. that is also common in many services. I also know of several Volunteer ambulances that bill for service to pay for equipment, trucks because they do not receive enough funding from the town to cover costs.

[Guest]

I couldnt agree more. This is terribly unethical. I would think that these fees for emergency services would discourage/keep the patrons from using this ems service in a time of need.

[Guest alsfirefighter]

Just about every hospital in this country gets some form for government support. Is it unethical for them to charge you when you walk in the door? And they charge for EVERY aspect, right down to a toothbrush.

Services cost money. Quality service costs big bucks. They are upfront about their rate plans, most big cities that bill for services are not. They are very clear about the service they have and staffing...24 FF/Paramedics and 3 staffed ambulances and a wheelchair service 24 hours a day. That cost $$ and I doubt the budget would allow for that, quality medical equipment and vehicles, with just tax based budgeting.

What would be unethical and ignorant and I still see this up close and personal often, is if they didn't have that staff, or any staff and billed. That is why I've always felt that the state needs to look into agencies that 3rd party bill and why is it they still have no supplemental staff to better response times and service. Also could it be deemed wrong to bill someone whom has some sort of insurance or medical coverage but the person who does not is not pursued? Or is it because some insurance companies deny payment and that is allowed to be let go also? Then what about when persons are sent a bill and they will never know that the agency that transported them only "soft bill." If they throw it away they will never get another...but the poor bastard whom pays it is out the cash.

As far as keeping them from using it in a time of need:

1. I'd be interested to see what their stats are in regard to the percentage drop in totally needless or nuisance calls. Ie, the EDP constant caller, the finger injury, toe injury, toothache, etc.

2. There are those whom don't use EMS services in the time of need now. No one seems too worried about the amount of serious walk-ins that still occur with no EMS response. And does billing anywhere else effect this? They are not the only place in the world that bills, most large cities do directly and many smaller ones as well. Look all around us and see whom bills, on top of contracts, on top of supplemental funding.

Edited January 23, 2007 by alsfirefighter

[mfc2257 464]

You guys are missing something here... Look at the location... It's Reading Township, PA.

In Pennsylvania there are VERY strict rules governing the levying of a fire tax by a municipality.

Roughly interpreted if it's not a CITY (think Yonkers or White Plains not Ossining) you cannot levy a fire tax. (A VERY ROUGH INTERPRETATION)

THUS, in order to provide the type of EMS services needed many agencies both 100% volunteer as well as volunteer supported by career bill for EMS services.

It's not to make a profit, inevitably they always face a fiscal loss, but it's to keep enough funding so the bank doesn't come and repossess the ambulance.

I've discussed it before, but most departments in Pennsylvania own their apparatus and building. They are self supportive through fund raising activities. The local municipality will often times contribute by paying a stipend to the company each year, but it's not even close to what it takes to keep the wheels turning.

The department I ran with during college is replacing it's 1977 Seagrave 100ft RMA with a 2007 Seagrave 100ft RMA... They will pay for it through donations, fund raising such as thier carnival, and finally with a small stipand from each of the municipalities that the unit covers for the rest the company will take a loan out and pay for it over time. You'll get more money for the truck as opposed to an engine, because it's only one of 2 aerial devices in the whole county so each municipality that has it listed as thier first due truck will contribute (think Katonah giving Bedford Hills a small stipand for the purchase of TL-57). With an engine, each of the 26 department's has at least one of their own so they won't be sharing any money.

www.gettysburgfd.com

There is nothing more heartbreaking then watching a bank repossess a piece of fire apparatus. It doesn’t just happen to country bumpkin departments either.

.

Edited January 23, 2007 by mfc2257

[antiquefirelt 994]

OK I guess I'm not clear how you guys do it in Westchester but, do you or the service bill insurance companies for the EMS provided? We run full ALS EMS in our area and are paid through the municipal budget (Fire/EMS dept.). We do not get donations (of an size) all equipment, salaries and costs are paid by the taxpayers. We bill the patient's insurance for any transports. By Medicare rules, any service that bill Medicare must bill every pateint transported utilizing their fee schedule which is basically set up just like the one detailed above. The maximum billing fees are based on a scale that fits a geographical area and the socio-economic factors for the region. Our max rates for example are like $300 for BLS and $450 for an ALS run, plus loaded miles. So according to Medicare we cannot fail to bill our residents and then bill anyone else (a common violation for many communities). The other issue is that you must bill the patient regardless of insurance status. The only thing that saves less fortuneate residents in our service area, is that the bills are written off after 12 months and do not go to collections.

Without this billing system our taxpayers would pay 66% more in taxes toward EMS (roughly $700K/yr)

[Guest]

No need to add much here, as the last three posts do a damn good job of it. I think people need to understand that while many agencies get varying degrees of federal, state and local aid you are never going to make a profit providing a 911 EMS service and are unlikely to break even. Aside from the expenses EMS care carries (ie: medications, equipment, and the like) your still going to have to pay your staff (if you have any), pay for insurance coverage for that staff, pay for insurance coverage on the apparatus, pay for fuel, factor in your routine and unexpected maintenance fees, etc. Those few things alone carry a hefty price tag. Even billing for services doesn't guarantee you anything - look at that Jersey consortium (forgot the name of it) that had to shut down a number of medic units because they could no longer afford to run them.

[tbendick 27]

It's becoming the norm to bill for EMS.. FDNY, and many EMS Depts in Westchester do bill. Some even pulled the EMS out of the FD on paper so that they would bill.

For some people they would not mind paying more each year in taxes, to support EMS. However when they do this and the EMS does not bill then who makes out??? The insurance company, so they the Corp Exec sitting on his boat thanks you for paying more taxes and not making his company pay for it.

The other way is the taxes pay for part of the EMS and then the billing pays for the other half or something else. Many of the VAC's now use it to pay for Daytime crews etc. Your health insurance doesn't go up if you use it..

There are many ways to look at it..

[helicopper 1,050]

Wait a minute - you mean actually pay for a service that I receive? The nerve!

Please forgive the sarcasm but I don't see anything wrong with charging the users of EMS service for that service - providing the fees are customary and reasonable and actually reflect the services provided!

It's like tolls - compare any other road in NYS with the Thruway after a snowstorm and invariably the Thruway is clear before other highways. Due, in part, to the tolls providing for the maintenance and a higher expectation for this level of service.

As has been posted before, many agencies now bill for service as a way of reducing the financial burden on the community as a whole. It's what we pay to have insurance for!

[mfc2257 464]

There is another form of billing out there as well that has gained some momentum in recent years.... Billing for extrications. Again this is mostly happening in states that are actually Commonwealths (Pennsylvania, Virginina, Mass., and Kentucky) where the laws governing taxation are slightly different.

So the gist of it is that if you are involved in a motor vehicle accident and the FD has to perform an extrication where hydraulic tools are used to facilitate removal, the FD bills the insurance company. In all honesty I've actually heard that most insurance companies are happy to pay that bill of a few thousand dollars usually because the sooner the pt can recieve medical treatment the less they will pay (in theory) in medical costs which we all know are excessive.

The city in Florida that I live in (Winter Park - 3 miles east of Orlando) bills non residents for exitrications. If you are a resident of the city and you are involved in an extrication needed rescue you will not be charged.

It just goes back to departments meeting the level of costs. If you break down the cost of providing a service for each incident that you go to, and there is a reasonable way of charging those who require the service without having to raise everyone elses taxes then in my mind it's worth it. Not to say that you charge for everything, BUT billing for reasonable items makes sense.

Edited January 23, 2007 by mfc2257

[Guest alsfirefighter]

Wow. So Pennsylvania is opposite of NY. If municipal FD's could charge a tax like fire distrcits can in NY, municipal departments would be much better off then most are.

I've also heard of billing for extrications and I am all for it. In addition I'm also all for departments seeking reimbursement at any incident where there is a hazmat involved and clean up materials (speedy dry, green stuff, booms, etc) are used. I do know of a few that does charge the insurance companies for the use of speedy dry at MVA's. This could also at least offset some of the costs of these materials and free the funding up for other areas/equipment.

[STAT213 332]

Ok, let me get this right...

BVFDJC, you really think this is "utterly unethical?" Come on dude. Do you think it is unethical for this? Does the water department charge your parents for using water? How about electrical services? At the landfill, do you have to pay a tipping fee? Not everything is covered by your beloved tax dollar. Where do you think the money for services will come from? With tax cuts, the money is not there. You have to make it up somewhere else. Billing does this. It is not unethical to bill people for value added services. You may not like it, fine. But using words like "utterly unethical". C'mon.

There are fire departments all over the state billing for transporting patients. Now, as I understand it, they have to set up a separate ambulance corporation to do it, but it is the guys from the FD in the ambulance.

[tbendick 27]

mfc2257 just reminded me of something..

For all the people that think you shouldn't bill because tax dollars go to EMS.. Then factor into all the people who don't pay taxes to that town.

Someone who works in the town but lives some place else, etc. How many of the calls that some of these VAC's respond to are for non residents.

[Guest]

You cannot sit back and look at this as a matter of dollars and cents. Granted, you could do this but it would offer you a very narrow frame of mind. Aside from the fact that your going to pay for everything today, no matter what it is, you have to look at what your paying for.

Life-Pak 12 w/ 12 Lead ECG, AED, Pacing, SpO2: $9,195.00 + Accessories

Full Compliment of ALS Equipment + Medications: At least $1,500.00

Full Compliment of BLS Equipment: At least $500 - $1,000.00

PA Certified Paramedic: $17 - $20/Hr?

PA Certified EMT: $7 - $13/hr?

PA Certified Ambulance: $100,000.00

While these are very, very rough estimates, your getting a pretty expensive package of resources when you call 911. If you ask me, your getting a pretty good deal - which many insurance companies cover either in full or partially.

Stat - that is correct, if an ambulance is part of an FD they cannot bill for services rendered because FDs are not allowed to bill. A VAC or rescue squad can, however because they are an independent entity.

[mfc2257 464]

You cannot sit back and look at this as a matter of dollars and cents. Granted, you could do this but it would offer you a very narrow frame of mind. Aside from the fact that your going to pay for everything today, no matter what it is, you have to look at what your paying for.

Life-Pak 12 w/ 12 Lead ECG, AED, Pacing, SpO2: $9,195.00 + Accessories

Full Compliment of ALS Equipment + Medications: At least $1,500.00

Full Compliment of BLS Equipment: At least $500 - $1,000.00

PA Certified Paramedic: $17 - $20/Hr?

PA Certified EMT: $7 - $13/hr?

PA Certified Ambulance: $100,000.00

While these are very, very rough estimates, your getting a pretty expensive package of resources when you call 911. If you ask me, your getting a pretty good deal - which many insurance companies cover either in full or partially.

Stat - that is correct, if an ambulance is part of an FD they cannot bill for services rendered because FDs are not allowed to bill. A VAC or rescue squad can, however because they are an independent entity.

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Again... FD's in NY cannot bill for service.... But in other states (like Pennsylvania where the article that this thread was started on) can bill for services.

The legislation that governs (burdons) emergency services in NY really has the the state locked in a handcuff of poor solutions. We (you guys since I'm techically no longer a resident) need to start lobbying for change. The most outrageous item that I've seen yet is that fact that you can't have a county wide fire department. Not to say that the individual agencies go away, but rather that they are governed by a central county authority. Until things at the leglislative level change, NYS will never be able to provide the OVERALL level of service to citizens, economy of scale to tax payers, safety to firefighters, resources for both paid and volunteer agencies that you currently get in even the most rural parts of Pennsylvania, California, Arizonia, Florida, Maryland, and Virginia.

The powers-that-be need to start taking ques from areas of the country that are doing it better, faster, safer, cheaper....

Edited January 23, 2007 by mfc2257

[mlfcemt093 0]

Monroe ems in orange cty bills we do a "soft" bill we bill the insurance and if we get no $$ from that we rcieve no help for expenses

[Guest DFC278]

Fire Departments in NYS can charge for EMS service. The City of Troy has been doing so for years. The City of Poughkeepsie can but has relied on a private service up until this time.

[Jybehofd 85]

Does any one know of any EMS agency supported by the government charging the residents for the use of their own EMS service?

I believe that it is utterly unethical for an agency to charge its users for the use of the that agency especially when that agency is supported by the government.

Does any one else feel that this idea is ridiculous charging the users is insane?

←

Well bvfdjc316 welcome to the United States idea of health care. It is a system that is in desire need of fixing. I don't feel its insane to pay for an ambulance, but you will for the most part have the same standard of care though. The real down fall is where insurance companies will not pay for "special surgeries or procedures" or you have to fight tooth and nail to get it done. Its almost better if you didn't have insurance and fell in that part where the hospital gets subsidized for treating you because you have no insurance and can't afford to pay the bill. Granted in the long wrong there is little to no fallow-up care but another run to the local ER. Where you see a doc for free or just about. I am not knocking it. Its a great thing and I support it all the way. I just feel the health care insurance in this country is broken and needs to be fix. But thats a different soap box.

On the Fire Department charging or billing its simple its called double dipping. They are getting tax money to run and operate and now you are billing for that service you recieve money to provide. Thats why FDNY EMS on paper is not on paper the fire department and why an "new or seprate" run number is given when an engine/truck or rescue is a assigned. Thus making it a fire department job.f

Edited January 23, 2007 by Jybehofd

[SRS131EMTFF 471]

Ok, let me get this right...

BVFDJC, you really think this is "utterly unethical?"  Come on dude.  Do you think it is unethical for this?  Does the water department charge your parents for using water?  How about electrical services?  At the landfill, do you have to pay a tipping fee?  Not everything is covered by your beloved tax dollar.  Where do you think the money for services will come from?  With tax cuts, the money is not there.  You have to make it up somewhere else.   Billing does this.  It is not unethical to bill people for value added services.  You may not like it, fine.  But using words like "utterly unethical".  C'mon. 

There are fire departments all over the state billing for transporting patients.  Now, as I understand it, they have to set up a separate ambulance corporation to do it, but it is the guys from the FD in the ambulance.

←

edited for the sake of my sanity

Edited January 24, 2007 by bvfdjc316

[antiquefirelt 994]

On the Fire Department charging or billing its simple its called double dipping. They are getting tax money to run and operate and now you are billing for that service you recieve money to provide. 

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So if these dept's didn't bill the taxpayers would pay twice as much or more for the same level of service. It comes down to simple mathmatics:

It takes $XXX.XX to run an EMS service. The municipality provides $XX.XX for that service, and billing returns $XXX.XX to the municipal coffers. The billing money normally must go into the municipalities general fund or a dedicated revenue fund for the EMS service which inturn offsets the amount of taxes needed next year to run the service. I have yet to hear of a municipality making a profit on EMS. If they are they are asking too much of their taxpayers.

As was mentioned earlier our system of taxation uses the tax and fee method to fund tons of major things:

Roads and Bridges: why have tolls? we pay for these in taxes.

Water/Sewer services: again billed for usage and also tax supported

Law Enforcement: large tax burden to municiplaity and also revenues from fines and fees for "extra" service. Why can't I get a cop for a private detail for free?

Municipal Administration Staff: Taxed for and then fees are collected to offset salaries and paperwork.

Landfill/Dump/Transfer Station: Tax supported, fees for pay as you throw or pick-up service. Hell, you pay three or four times for recycleable items!!

EMS: tax supported, insurance/pt. billed for services rendered.

As a taxpayer I would rateher see more user fees. Why should I pay for services that I don't use? If I live on the outskirts of town and pay the tax tax rate, do I get the same response time from Fire, EMS and PD? Does my road get plowed as often as intown streets? In the end if tax dollars are the only thin that pay for municipal services we will have a socialist system reduced to the level of care we can afford to give the citizenry as a whole. As noted above how about all the renters who don't pay taxes? Raise the apartment building taxes and let landlords raise rent? Better find a bigger homeless shelter!

[antiquefirelt 994]

IT IS WITHOUT A DOUBT IN MY MIND THAT CHARGING FOR A SERVICE THAT NOT ONLY IN SOME PARTS OF THE WORLD, THE UNITED STATES, THE STATE OF NEW YORK OR EVEN THIS COUNY IS FREE, IS TOTALLY, UNEQIVICALLY WRONG.....that being said state of health care in this nation is without a doubt a ruin and we as americans should be ashamed.....there is no conection between a luxury (which not everyone pays for aka if they have a well) or garbage (which again not everyone pays for if their town does not have a public garbage facility) the Candians have it right..universal health care free for one and all.

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Ask a Canadian how they like their Healthcare system. Sure you get basic healthcare for free. Basic is the key word. Many people wait for years for surgerys and procedures that most Amaericans would have done in a month using basic insurance coverage. We do have basic healthcare for everyone, how many homeless people do you refuse to take to the hospital? How many people are tossed out in the street without "basic" care? Is our system broke? Yes, we do need reform, but this has nothing to do with billing for EMS services.

If anyone expects me to pay for something that it is the governments job as stated in the consitutions bill of rights which i hope that most of us here still swear by and i quote "...LIFE, liberty and the pursuit of happiness." they are utterly mistaken.

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Do you understand that WE ARE THE GOVERNMENT? We are the ones who are paying for all public services. For every dollar raised in revenue, that is one less dollar we are taxed for. Pretty basic government.

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It is the job of our government or any government to provide for the saftey of their citizens....if they can or can not pay that should not be the issue............it should be free much the government that we pay for....and yes the taxes we pay are for the government to help us not the government itself

sorry for the rant im just a tad ticked off

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Again we are the government, so it is us that can or cannot afford any and all services. Now, a fairer tax system (flat tax) and some healthcare reform and some reasonable scrutiny of goevernment spending and we may be able to offer better services for less or equal money. But I won't hold my breath.

[Guest]

If a person were to suffer an out-of-hospital cardiac event and survive to pay a $50,000 ICU bill, isn't the $800 ambulance that got them to the ICU a bargain? Sheeesh, $800 to save my life. Where do I pay?

[Amato122 0]

Billing is a necessary evil for urban EMS systems like FDNY. If they didn't charge the call volume would be double. People I lie to you not, would call just to get from one neighborhood to another. If it was a free system, NYC could say goodbye to their budget surplus in about an hour. I'd say close to half of FDNY-EMS calls are paid by medicare/medicaid. It would be a disaster if the other half and then some were taxpayer provided as well.

Billing for EMS calls on the island and in Westchester is a little more complicated, where "generally(used loosely)" people call ambulances for genuine emergencies. I was never a member of a VAC but I understand most send out a "bill" with a suggested donation, I could be wrong though?

[Guest]

IT IS WITHOUT A DOUBT IN MY MIND THAT CHARGING FOR A SERVICE THAT NOT ONLY IN SOME PARTS OF THE WORLD, THE UNITED STATES, THE STATE OF NEW YORK OR EVEN THIS COUNY IS FREE, IS TOTALLY, UNEQIVICALLY WRONG.....that being said state of health care in this nation is without a doubt a ruin and we as americans should be ashamed.....there is no conection between a luxury (which not everyone pays for aka if they have a well) or garbage (which again not everyone pays for if their town does not have a public garbage facility)  the Candians have it right..universal health care free for one and all. 

If anyone expects me to pay for something that it is the governments job as stated in the consitutions bill of rights which i hope that most of us here still swear by and i quote "...LIFE, liberty and the pursuit of happiness." they are utterly mistaken.

It is the job of our government or any government to provide for the saftey of their citizens....if they can or can not pay that should not be the issue............it should be free much the government that we pay for....and yes the taxes we pay are for the government to help us not the government itself

sorry for the rant im just a tad ticked off

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Buddy, first and foremost. EMS/Fire protection is not something the Constitution of the United States grants. We, in the United States, enjoy a unique form of government called federalism. Essentially, there are a number of issues that are left solely up to states (aka states rights) to has out. While the state (...ill use NY for the hell of it) sets out a basic operating framework for EMS, it does not run it. Instead, the State has defaulted on the Counties/towns/village (aka local government) to use the state framework to create an applicable solution for their individual county/town/village.

While all residents of Westchester likely pay some form of an "ambulance tax" it should be noted that more often than not, this amounts to a few dollars a household depending on the needs of your local municipality. These small taxes amount to a small portion of an VAC or EMS Agency's operating costs. Like i said before, and i will say it again, providing 911 emergency medical services is never going to net you a profit! In other words, YOU LOSE MONEY BY PROVIDING 911 EMS! Those of us who do this as a career need to be paid, and both career and volunteers need to be covered under insurance while on duty, fuel needs to be bought, ambulances need to be insured, re-inspected, repaired, maintained, uniforms need to be bought, and the list goes on, and on and on. If agencies don't bill, that ambulance doesn't roll. Plain and simple.

[Guest partyrock]

People I lie to you not, would call just to get from one neighborhood to another. If it was a free system, NYC could say goodbye to their budget surplus in about an hour. I'd say close to half of FDNY-EMS calls are paid by medicare/medicaid. It would be a disaster if the other half and then some were taxpayer provided as well.

←

Absolutely right. Working the side money last week, I had a patient refuse transport because she wanted to go to Jacobi (litteraly half a block from her building) and it was on diversion. Instead of waiting at jacobi or going to another hospital she chose to wait till she went to work the next day down the street from Westchester Square.

As for medicade money...its one pre-negotiated payment. No matter how many we pick up the city all ready has its medicade money for the year.

[STAT213 332]

BVFDJC,

Edited for the sake of your sanity? Too bad everyone copied your post before you could pull it. C'mon kid. Don't you get it yet? Stuff just ain't free. Be nice, but...it just ain't.

You mentioned the Bill of Rights. First the Bill of Rights is from federal government, not state. Last time I looked on the side of an ambulance, it wasn't a federal service coming to my aid. Second, there isn't much in that there document about EMS. People didn't much care about EMS until oh...1966. Oh, and what fun it would be if this was a state system. Oh wait...that is socialism where the government provides everything for everyone.

Buddy, I feel your pain. You seem passionate about this rant you are on. Passion is good. I can remember being your age and jumping up and down about things. I once convinced my dad that his buying a car with a/c would ruin the planet. Being a good dad, and a cool dad, he caved. I have since realized my folly. As a junior (meaning younger) of this board, watch, listen, look around prior to rants. Said behavior also is VERY helpful as a new guy in the fire service. VERY helpful. Also, please don't take this post as me trying to slam you. I am not. If I were, I would have been much more blunt and mean. Trying to offer some advice, cause I have been where you are. As we say, been there done that.

[Guest]

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.

[IzzyEng4 427]

Unreal, Unethical Billing?????? So municipally funded agencies can not bill for the replacement of equipment use, gas and repairs to apparatus that are transporting you??? Redding's billing is no wheres even close to what private ALS /BLS ambulance services bill and privates are FOR PROFIT! Granted most of the billing is covered by Medicare or other medical insurance companies but the days of a totally free service are gone. If agencies didn't charge they would be so far over budget that it could force layoffs and could cause a city to go deep into the "Red" with their budget and it has happened, just read the newspapers of agencies dropping municipal, district or fire department funded EMS.

My fire department has just started to bill for motor vehicle accidents and hazmat cleanups, why??? Because the equipment we have to use cost a lot to replace and since we do get a lot of accidents, we go through out supplies quick. heck I think FD should be able to submit or levy a fie for re-occuring false alarms at commercial businesses and residential homes especially if the alarm system doesn;t get fixed, the PD can do it and most towns have ordnances for this as well.

Billing for services in EMS is nothing new and if equipment prices go up, so due the agency's rates.

[Guest alsfirefighter]

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:

the Candians have it right..universal health care free for one and all. 

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.

If anyone expects me to pay for something that it is the governments job as stated in the consitutions bill of rights which i hope that most of us here still swear by and i quote "...LIFE, liberty and the pursuit of happiness." they are utterly mistaken.

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.

[Guest]

Down here in MD we do bill the PT for for services given. I know for a fact that our Dept. depends greatly on the billing of these calls to function. Yes we do receive aid from the county and the state but growing up in Westchester it is not even close to the help that is given to Depts. up there. The money we receive is very minimal and are almost forced to use this as a method of survival. The bills that are sent to the pt in my district are never paid half the time anyway because of large amount of low income areas that we protect. We send out the bills with the hope that they will be paid but it really comes down to that we take what we can get