Bethel begins billing for ambulance service

[pfdfirefighter01 1]

Danbury News Times

By Marietta Homayonpour

July 24, 2008

A 68-year-old tradition ended this month when the Bethel Volunteer Fire Department began billing for ambulance service to the hospital. "It came about because of a dwindling number of volunteers during the daytime and the need to supplement our volunteer staff to meet the needs of covering all the calls," Bethel Fire Department Chief Fred Ingram said.

http://www.newstimes.com/ci_9978592

[Raz 14]

I always love how Volunteer EMS services will bill you, but still send you letters in the mail asking for donations and claiming "we provide a vital service to our community for free!"

[WAS967 97]

Don't forget, you get what you pay for. Billing for services and using the funds to hire a crew to staff the ambulance(s) sounds like a better situation than not getting out and risking having the town ambulance corp shut down completely.

[Guest]

Don't forget, you get what you pay for. Billing for services and using the funds to hire a crew to staff the ambulance(s) sounds like a better situation than not getting out and risking having the town ambulance corp shut down completely.

They were on the verge of being shut down by the state. Years of missed calls, and illegal, uncertified crews finally caught up with them.

[Goose 188]

They were on the verge of being shut down by the state. Years of missed calls, and illegal, uncertified crews finally caught up with them.

Glad to see the state took serious action.

[Guest]

I always love how Volunteer EMS services will bill you, but still send you letters in the mail asking for donations and claiming "we provide a vital service to our community for free!"

With the economy the way it is right now, donations have dropped, fuel prices have soared, volunteers have dwindled...What are the VACs alternatives? Some agencies only bill insurance and wash the bill for those who don't have coverage. If they are only charging the insurance company then they are providing a free service. This being the case, donations are still needed. There is still the "Volunteer Pride" issue and it takes a lot for leaders and members of VACs to admit they have staffing issues and take the necessary steps to cover calls. The other solution is to become a municipal agency and be supported via taxes, which I am sure most residents and business owners wouldn't want to pay anymore in taxes!

Edited July 25, 2008 by x710

[Guest]

With the economy the way it is right now, donations have dropped, fuel prices have soared, volunteers have dwindled...What are the VACs alternatives? Some agencies only bill insurance and wash the bill for those who don't have coverage. If they are only charging the insurance company than they are providing a free service. This being the case, donations are still needed.

good explaination. for once, a level headed response with regards to vac's billing.

[ny10570 745]

I love that argument. We're only billing the insurance company so its still a free service line of thought is completely wrong. That is just spreading the bill out amongst a larger population. You want to subsidize people based on need, thats a whole different issue but to give people a free ride because they either don't have insurance or choose to not provide yuou that information is absurd.

[helicopper 1,050]

With the economy the way it is right now, donations have dropped, fuel prices have soared, volunteers have dwindled...What are the VACs alternatives? Some agencies only bill insurance and wash the bill for those who don't have coverage. If they are only charging the insurance company then they are providing a free service. This being the case, donations are still needed. There is still the "Volunteer Pride" issue and it takes a lot for leaders and members of VACs to admit they have staffing issues and take the necessary steps to cover calls. The other solution is to become a municipal agency and be supported via taxes, which I am sure most residents and business owners wouldn't want to pay anymore in taxes!

I'm sorry but I fail to understand how billing the insurance company equates to free service?!?!?! If they're billing, it's not free. There may be no salaries involved but that doesn't make the service free. As for taxation to support the service, depending on the community the tax bill would be very modest.

And there are a lot of VAC's who receive tax subsidies and bill for their service and still ask for donations to support various projects.

[Guest]

I'm sorry but I fail to understand how billing the insurance company equates to free service?!?!?! If they're billing, it's not free. There may be no salaries involved but that doesn't make the service free. As for taxation to support the service, depending on the community the tax bill would be very modest.

And there are a lot of VAC's who receive tax subsidies and bill for their service and still ask for donations to support various projects.

If your insurance company pays, what does that cost you? Nothing, just Cigna, Oxford, and the others lose money, big deal. So isn't that free? Would you rather be in a municipality like Yonkers where Empress puts you into collections?

Can you estimate for me what equates to modest taxes for EMS?

[WAS967 97]

Nothing, just Cigna, Oxford, and the others lose money, big deal. So isn't that free?

No it isn't. You pay for it via your premiums. Mine just went up almost 17%. Next year I'll likely be paying over $50 a week just for medical insurance. :angry:

[Bnechis 3,961]

Some agencies only bill insurance and wash the bill for those who don't have coverage.

This is refered to as "soft billing" and its illegal. Check the medicare rules carefully. It is commonly done...but there are ways to do it and there are ways to get in big trouble with the feds on this one.

[Raz 14]

With the economy the way it is right now, donations have dropped, fuel prices have soared, volunteers have dwindled...What are the VACs alternatives? Some agencies only bill insurance and wash the bill for those who don't have coverage. If they are only charging the insurance company then they are providing a free service. This being the case, donations are still needed. There is still the "Volunteer Pride" issue and it takes a lot for leaders and members of VACs to admit they have staffing issues and take the necessary steps to cover calls. The other solution is to become a municipal agency and be supported via taxes, which I am sure most residents and business owners wouldn't want to pay anymore in taxes!

It looks like I got beat to the punch in debating some of your points. In addition to what others have said, I also know that there are VACs that receive tax money from the town, bill patients, and staff a paid EMT or crew to cover their calls during certain hours. If that's the case, wouldn't you agree that it takes balls to send out a letter asking for donations while claiming to be volunteers that provide a free service to the community?

Edited July 26, 2008 by Raz

[Guest alsfirefighter]

With the economy the way it is right now, donations have dropped, fuel prices have soared, volunteers have dwindled...What are the VACs alternatives? Some agencies only bill insurance and wash the bill for those who don't have coverage. If they are only charging the insurance company then they are providing a free service. This being the case, donations are still needed. There is still the "Volunteer Pride" issue and it takes a lot for leaders and members of VACs to admit they have staffing issues and take the necessary steps to cover calls. The other solution is to become a municipal agency and be supported via taxes, which I am sure most residents and business owners wouldn't want to pay anymore in taxes!

Sorry...but I find that to be a weak, smoke and mirrors answer. What are the VAC's alternatives? I don't see plausible deniability as one of them.

Yet again we hear the "residents and business owners wouldn't want to pay more taxes" comment. There is a difference between wouldn't want to and don't want to. Fact is if you educate them and have good statistics a high percentage would understand and guess what...if it has to be done...they have to pay them anyway...or move to a place to pay equally higher taxes or lower I guess and get less services. For those that still want to complain about it, the answer is also pretty simple...unless you can start manufacturing people or cloning the ones you have...it is what it is. Complain about some of the other silly crap that money gets spent on. Perhaps if some agencies actually started having discussions and being forthcoming about the issue, giving time to develop financing strategies to improve staffing, rather than wearing rose colored glasses and turning their back to the pink elephant in the room, things would work. Its rather easy to say "it will cost too much" or we are doing well, we have one of the lowest mutual rates in the county. Real leaders and managers say we have a problem, its not going to be easy to fix on many levels but lets dive in it and see what our options are. Anyone can discount why an issue won't work because it takes 1 line quips. Thank god over the course of history technological advances weren't handled the way fire and EMS services are. The car wouldn't work, the plane wouldn't fly, it would have cost too much to go to space and forget about the moon.

[Guest]

No it isn't. You pay for it via your premiums. Mine just went up almost 17%. Next year I'll likely be paying over $50 a week just for medical insurance. :angry:

i promise you the reason your premiums went up has NOTHING to do with vac's billing. the reason many premiums went up is due to 2 things - the increase of doctors fees/equipment/supplies and fraud. ems has nothing to do with it. the percentage of this market that ems has is so small, it's pathetic. i work in the field of billing at wmc, i've seen this.

like x710 mentioned, would you as a potential patient rather have the town vac bill your insurance company and leave your personal expenses out of it or have a ems COMPANY take your a$$ to collections - the answer is very, very obvious...that's why we do it.

of all the things to complain about, vac's billing is at the end of the list.

my brother got in a car wreck on the 4th of july, he went to wmc and was there for LESS THAN ONE HOUR. last week he got a bill in the mail for the "medical services" rendered at wmc by THE COMPANY THAT CONTRACTS THEIR DOCTORS TO WMC - the emergency attendings at wmc are NOT wmc employees. the bill from the contracting company was $180.

today he just got a bill in the mail from wmc itself for the "usage of the facility" and this bill is $850!

would you like to know what they did for my brother? took a small piece of glass out of his arm and gave his some gauze!

i know eventually no fault will pay for this service, but my point is - ems is a medical service and as we all know it's not a civil service, although some think it should be. civil service rules shouldn't apply to a NON-PROFIT MEDICAL SERVICE - why? because these services in the medical field are going extinct.

some of you annoying career people want all cities and towns to be under your COMPANY'S contracts, but you have no idea what the ramifications of this will do. i would explain, but it would take me hours to write. the best service is a municipal ambulance corps that is conscious of its own district.

paid or vollie doesn't matter, as long as the ambulance and crew is there when called upon and better so when the patient does not have to foot a single penny.

Bethel FD - you guys/gals did the right thing, rather than saying "F" it and getting a contract company do to it. Best of Luck.

[gamewell45 258]

paid or vollie doesn't matter, as long as the ambulance and crew is there when called upon and better so when the patient does not have to foot a single penny.

vacguy, you are correct in your thinking. Excellent response.

[helicopper 1,050]

If your insurance company pays, what does that cost you? Nothing, just Cigna, Oxford, and the others lose money, big deal. So isn't that free? Would you rather be in a municipality like Yonkers where Empress puts you into collections?

Can you estimate for me what equates to modest taxes for EMS?

Insurance premiums most certainly do go up in part because of EMS billing, not just EMS billing, but it is part of what drives insurance companies rate adjustments. Imagine a $10,000 STAT-Flight bill that is not covered by someone's insurance. They're going to make that 10K back off someone, most likely all of us! Insurance companies don't lose money! They just keep jacking up our rates to balance their bottom line regardless of whether or not our bottom line suffers.

If I had to pay $150.00 a year to guarantee that I had EMS coverage, I'd gladly do it. That would give the EMS provider in my town just about $1,000,000 to operate with. I consider that a modest tax considering my school taxes are over $6,000 per year.

Why do so many people cling to the idea that EMS can be "free". It costs money to provide the service (fuel, insurance, equipment, building, phone, etc.) excluding personnel.

vacguy, I assume you meant you'd prefer that nobody got a bill for emergency medical care (EMS or ER). Why shouldn't the users of the service pay for it?

[Guest alsfirefighter]

i promise you the reason your premiums went up has NOTHING to do with vac's billing. the reason many premiums went up is due to 2 things - the increase of doctors fees/equipment/supplies and fraud. ems has nothing to do with it. the percentage of this market that ems has is so small, it's pathetic. i work in the field of billing at wmc, i've seen this.

like x710 mentioned, would you as a potential patient rather have the town vac bill your insurance company and leave your personal expenses out of it or have a ems COMPANY take your a$$ to collections - the answer is very, very obvious...that's why we do it.

of all the things to complain about, vac's billing is at the end of the list.

my brother got in a car wreck on the 4th of july, he went to wmc and was there for LESS THAN ONE HOUR. last week he got a bill in the mail for the "medical services" rendered at wmc by THE COMPANY THAT CONTRACTS THEIR DOCTORS TO WMC - the emergency attendings at wmc are NOT wmc employees. the bill from the contracting company was $180.

today he just got a bill in the mail from wmc itself for the "usage of the facility" and this bill is $850!

would you like to know what they did for my brother? took a small piece of glass out of his arm and gave his some gauze!

i know eventually no fault will pay for this service, but my point is - ems is a medical service and as we all know it's not a civil service, although some think it should be. civil service rules shouldn't apply to a NON-PROFIT MEDICAL SERVICE - why? because these services in the medical field are going extinct.

some of you annoying career people want all cities and towns to be under your COMPANY'S contracts, but you have no idea what the ramifications of this will do. i would explain, but it would take me hours to write. the best service is a municipal ambulance corps that is conscious of its own district.

paid or vollie doesn't matter, as long as the ambulance and crew is there when called upon and better so when the patient does not have to foot a single penny.

Bethel FD - you guys/gals did the right thing, rather than saying "F" it and getting a contract company do to it. Best of Luck.

First I have to say I enjoy your posts on this thread...you spell out your thoughts and opinions very well with fact. Its nice to see that.

For some of us...VAC billing isn't at the end of the list when I work in an area where there are VAC's that bill and have no staffing, yet I have to wait for a 3rd or 4th agency to come in and cover a call. Many also do not disclose what they make yearly on their billing.

As far as annoying career people...I have to agree partly with you for I have seen how some of them work with trying to get contracts and whooing municipalities. I for one do not work for any company, haven't for a long time and never have as a career only part time and I will never again. I can guarantee you that I never want my municipality to be under a contracted EMS provider. I make no quarms that I believe fire based ems when run right, with the right management would be the best overall. I just don't play the taxes game and even if they were paying taxes I think billing is still fair. Again, no different then any other extra service in a municipality you pay for from building permits, to trash pick up, etc.

[Guest]

Insurance premiums most certainly do go up in part because of EMS billing, not just EMS billing, but it is part of what drives insurance companies rate adjustments. Imagine a $10,000 STAT-Flight bill that is not covered by someone's insurance. They're going to make that 10K back off someone, most likely all of us! Insurance companies don't lose money! They just keep jacking up our rates to balance their bottom line regardless of whether or not our bottom line suffers.

If I had to pay $150.00 a year to guarantee that I had EMS coverage, I'd gladly do it. That would give the EMS provider in my town just about $1,000,000 to operate with. I consider that a modest tax considering my school taxes are over $6,000 per year.

Why do so many people cling to the idea that EMS can be "free". It costs money to provide the service (fuel, insurance, equipment, building, phone, etc.) excluding personnel.

vacguy, I assume you meant you'd prefer that nobody got a bill for emergency medical care (EMS or ER). Why shouldn't the users of the service pay for it?

as mentioned, unlike some other civil services the medical field HAS insurances - from ems to doctors. a vac bills the INSURANCE COMPANY, no matter what the vac actually bills for, the insurance company will pay you what THEY think your ems services are worth and there is nothing you can do about it. private insurances are the pain in the a$$, government insurances usually pay out well - minus medicaid.

sure, you can appeal it - this appealing process also applies to my job as well and trust me, appealing their decision is nothing but a waste of time...and sometimes money. whatever they pay you, just let it be.

the point is that VAC's are NOT around to MAKE A PROFIT, unlike COMPANIES, they are there to provide a service to civilians, yet is is not a civil service. the end of each fiscal year a VAC must have a profit of ZERO as i'm sure you know. if the insurance companies are not paying out to the vac's the amount requested - that's ok as long as the funds used for the paid people is replenished, thus the whole purpose of billing.

there is no need to foot the bill to the patient because the sole goal of the billing has been met. that's why i think it is unnecessary to have the individual patients pay for their transports. just like any non-profit organization if money is needed to be raised, a plan SHOULD be in place for each specific goal. rightfully so, a vac may earmark surplus funds to other NECESSITIES the vac may have in the future and your auditor should be ensuring this.

if you look at ems as a civil service, i can understand your frustrations with vac's billing. but, ems is not a civil service, it's a non-prifit medical service - a rare entity. second to that as long as COMPANIES have the right to bid contracts for municipailties i hope ems NEVER becomes a civil service. if vac decides to staff their rigs, they should still keep the board of directors as volunteer members and civilians. officers too should be paid.

as far as stat flight, they really shouldn't be compared to ground municipal ems. if medical services were properly placed throughout the regions, there would be no need for the bird. the need for the bird is a superseding necessity, if the option was to die or live and be stuck with a $10k bill...the $10k bill is the last of the problems, especially once you get the $30k bill from the hospital bc your insurance company will only pay 70% of the $100k total. i can go on and on...and on...and on with this, but my original idea stands and that of all the things to b**** about in life, bitching about vac's billing is so minuet. especially once patients get the bills from the hospital, thery're going to be thankful that their small town vac only charges their insurance companies and that even if the insurance company only pays 70% , the patient doesn't need to pay!

vac's billing because they use paid is a win-win situation - it's in the best interest for the patient and the vac. and once again, who the hell cares if it's paid or vollie - as long as the ambulance gets out the door in a timely fashion and the crew does their job.

a non-profit organization is a business, and the best the business world had to offer, usually with the best of people running it, and it should be ran like a business - not like a bureaucracy.

Edited July 27, 2008 by vacguy

[Bnechis 3,961]

a vac bills the INSURANCE COMPANY, no matter what the vac actually bills for, the insurance company will pay you what THEY think your ems services are worth and there is nothing you can do about it. private insurances are the pain in the a$$, government insurances usually pay out well - minus medicaid.

Actually most insurance companies base the amount they pay on the Medicare Rate (which is set by the Federal Government).

the end of each fiscal year a VAC must have a profit of ZERO as i'm sure you know.

But a profit of Zero does not mean they can't have a surplus of millions.

there is no need to foot the bill to the patient because the sole goal of the billing has been met. that's why i think it is unnecessary to have the individual patients pay for their transports.

If you are billing Medicare or Medicaid, then you must bill the individuals (for the remainder of the bill or the whole bill if they are uninsured)....Its the LAW.

a vac may earmark surplus funds to other NECESSITIES the vac may have in the future and your auditor should be ensuring this.

Correct (see surplus above)

second to that as long as COMPANIES have the right to bid contracts for municipailties i hope ems NEVER becomes a civil service

What do companies and civil service have to do with one another? True Municipal EMS (they run the whole system) is often but not always civil service....Commercial services that are cntracted are almost never civil service.

even if the insurance company only pays 70% , the patient doesn't need to pay!

If the insurance companies find out that's what your doing, they may decide to report your agency to the Feds. Then you may find it costing you a whole lot more. And the Medicare whistle blowers law gives the person who reports you a % of the fine....nice incentive.

[Guest]

Actually most insurance companies base the amount they pay on the Medicare Rate (which is set by the Federal Government).

But a profit of Zero does not mean they can't have a surplus of millions.

If you are billing Medicare or Medicaid, then you must bill the individuals (for the remainder of the bill or the whole bill if they are uninsured)....Its the LAW.

Correct (see surplus above)

What do companies and civil service have to do with one another? True Municipal EMS (they run the whole system) is often but not always civil service....Commercial services that are cntracted are almost never civil service.

If the insurance companies find out that's what your doing, they may decide to report your agency to the Feds. Then you may find it costing you a whole lot more. And the Medicare whistle blowers law gives the person who reports you a % of the fine....nice incentive.

you are correct - medicare and medicaid have limits to which one may bill, but that does not at all mean that's the amount they give you. like i said it depends on the service and the severity of the situation and they determine what is par and under par service and may down code the severity of the ambulance transport.

companies and civil service ems have nothing to do with each other, i think they actually negate each other. one is for the greater good, the other is for the greater bank accounts. that was the point

as for what you make to seem like a scam - it's perfectly legal. believe me, many people from other agencies have brought this to the attention of legal services and every legal aid has cleared it. some may call this "soft billing" but it's not, i'm not quite sure what the specifics of soft billing consists of, but i assure you this is a legally and morally just system.

[Bnechis 3,961]

as for what you make to seem like a scam - it's perfectly legal. believe me, many people from other agencies have brought this to the attention of legal services and every legal aid has cleared it. some may call this "soft billing" but it's not, i'm not quite sure what the specifics of soft billing consists of, but i assure you this is a legally and morally just system.

All soft billing is......everyone you transport gets a bill...if they dont pay, you dont send them to collections. The fact that everyone gets a bill is what makes the whole thing legit.

[Goose 188]

you are correct - medicare and medicaid have limits to which one may bill, but that does not at all mean that's the amount they give you. like i said it depends on the service and the severity of the situation and they determine what is par and under par service and may down code the severity of the ambulance transport.

companies and civil service ems have nothing to do with each other, i think they actually negate each other. one is for the greater good, the other is for the greater bank accounts. that was the point

as for what you make to seem like a scam - it's perfectly legal. believe me, many people from other agencies have brought this to the attention of legal services and every legal aid has cleared it. some may call this "soft billing" but it's not, i'm not quite sure what the specifics of soft billing consists of, but i assure you this is a legally and morally just system.

That’s an ignorant and problematic statement and only highlights the fact that you apparently have no experience in either type of system.

While I am a adamant supporter of having EMS as a completely independent civil service, the facts on the ground are that this is unlikely to happen in the near future. Right now commercials fill a very real void/disconnect between the reality on the ground and the ineptness of politicians and the political process more generally.

Given that, to try and say that commercial agencies are money hungry machines and they – essentially the field personnel who are employed by said company – don’t represent some form of altruism/caring/compassion bothers me.

For the sake of intelligent discussion, I suggest you redirect your frustration to your local/state/federal representatives who have and continue to drag their feet on addressing the reality.

And for what it's worth i no longer work commercial EMS.

Edited July 28, 2008 by Goose

[JohnnyOV 2]

i know eventually no fault will pay for this service, but my point is - ems is a medical service and as we all know it's not a civil service, although some think it should be. civil service rules shouldn't apply to a NON-PROFIT MEDICAL SERVICE - why? because these services in the medical field are going extinct.

There is a difference between Non-profit and Not for Profit Organizations. A Not - For - Profit corporation (which I believe most VACs are [Volunteer Ambulance Corporation]), does not pay its owners / members, but can take in money and make a profit. A non - profit organization does not need to register as a corporation, and cannot turn a profit.

[Guest]

There is a difference between Non-profit and Not for Profit Organizations. A Not - For - Profit corporation (which I believe most VACs are [Volunteer Ambulance Corporation]), does not pay its owners / members, but can take in money and make a profit. A non - profit organization does not need to register as a corporation, and cannot turn a profit.

you are right, they generally are not-for-profit. non-profit could be, for example, a third party company that is helping about another company/person. my apologies.