Monday, June 30, 2008

What Do You Think About the Proposed Ambulance Fee?

We are now considering an Emergency Medical Services Transport Fee, also considered an ambulance fee. The charge for transportation in a medical emergency would be billed directly to an individual’s health insurer, although County residents without insurance would not pay for emergency transports to the hospital. According to the County Executive, who brought the bill to the Council, revenues generated by the fee would help the County keep pace with the public safety demands of our growing community. He adds that all of the region’s surrounding jurisdictions have implemented similar fees without reducing the willingness of individuals to call for emergency service transports. The bill assumes an average fee of about $250 per transport. Let me know what you think.


Bob said...

I support charging ambulance fees pegged to the going market rate in neighboring jurisdictions (or higher if the operational cost justifies higher fees). I also support charging a fee even for those who do not have health insurance. That fee can be scaled to whatever the user (user's family) can pay. Just because an individual doesn't have health insurance doesn't mean they can't afford to pay some amount. Likewise, someone with health insurance may not have their ambulance trip paid for due to coverage limitations, etc., but they still shoulc be billed for the service.

Anonymous said...

Are you sure that all insurance companies will pay for the fee? If so then I have no objection to it. However, if it is unclear whether all insurance companies will cover the fee then I would have reservations, as the policy could have a disproportionate effect on people with certain types of life-threatening medical conditions (e.g. congestive heart failure) that may necessitate more regular use of the ambulance services.

Marc said...

Hi Nancy,
What a great idea to invite constituent comments on policy matters via the intranet, and to do it in a blog so that others can read and respond. Congratulations on this step!
I know many people won't like an ambulance fee because it's better to have it "free" to the user. In this case (and many others), "free" means that person 1 gets to use the service and persons 2, 3, 4 and 5 get to pay for it.
I favor the idea of user fees generally. Users should pay for services they use. I agree that poor residents should be subsidized by wealthier residents, that's only fair. It's also fair for people to pay for what they use, this helps to encourage people to use ambulance services wisely, and to call for the ambulance when they really need it, not when they think they might need it.

Anonymous said...

How are the ambulances paid for now? I assume by the taxpayers. Correct me if I'm wrong.
How will they be paid for under the new plan? By the insurance companies we are told. Where do they get their money ? Guess what - from the insured, you and me. So what have we gained by confusing the whole thing, but more paper work and expense to be gotten from - the taxpayers again. The uninsured will get it free as they do now unless they pay taxes.And if they pay any taxes that will help us all with the ambulance costs.

Bob Chapman said...

I think your proposed fee for Ambulance services is disgusting. It is easily explained away as “the fee will be passed on to your medical insurance”. Evidently you don't have enough sense to realize that any fee like this that is "just passed on" results in ever increasing insurance costs that just keep going up even faster. Who pays? I pay! What happened to all the taxes I already pay? Next you are going to want to bill my homeowners insurance when the fire department comes to put out the fire at my house. When will you ever STOP!

Robert Oshel said...

I am strongly opposed to any ambulance fee. This is a basic public safety service similar to police and fire. The fact that insurance might pay for it makes no difference since we all will only pay more in the long run in higher insurance premiums, which would include an added amount for insurance overhead expenses and profit. The possibility that the fee might cause even one person to hesitate to call for an ambulance in an emergency and potentially lead to a loss of life must also be considered. Additionally, the likely lower contributions to the volunteer rescue squads should be taken into account. The ambulance fee might be considered "easy revenue" in tough times for the county, but it's imposition would be a major error in judgment. Montgomery County is better than that. [PS: I have never called for an ambulance and am not connected with any of the volunteer fire departments or rescue squads. I do work in public health for the U.S. Dept. of Health and Human Services.]

Mateo said...

an ambulance is a fine idea if you're rich, not so good if you don't have the $250 to spare. those people probably aren't commenting on blogs though!

Anonymous said...

If general funds for ambulance services are insufficient, then user fees make sense to the extent that cost controls remain in place - user fees shouldn't be in place if it's merely a mechanism to pass on increasing costs.

I agree with one of the previous posts: there must be some link with the services provided and costs paid, otherwise, there is no incentive to use the services judiciously. It's the old "free rider" problem.

To Bob Chapman's comment: someone is going to have to pay for it in the long run whether it's through taxpayer dollars or indirectly by constituents through their med insurance provider.

Anonymous said...

I think this is a bad idea. People who are unsure about whether insurance will pay may not call for an ambulance. Death may be the price. We never know how much it may cost and what insurance may or may not pay. I once was transported from Holy cross to Wash. Adventist in Takoma Park and the fee was $1000. My insurance denied the fee.

Anonymous said...

Council member Floreen:

I think that this proposal is an outrange considering the current budget reflects that the Fire & Rescue Services will generate $12 million dollars in surplus over its projected expenses.
Would you be so kind as to tell your constituents which side you are on ?????
And please do not say that you have yet to make up your mind. The people that vote have already made up their's.

Thomas Hardman said...

Ms Floreen,

Some folks will suggest that it's only reasonable to have ambulance fees comparable to those of neighboring jurisdictions. Yet perhaps you might examine why those jurisdictions have ambulance fees?

In many places around the country, ambulance fees are effectively a "cost shifting" mechanism designed so that the well-heeled can support costs of service for people who are unable to pay for the service.

We see comparable cost-shifting in the pricing set by hospitals for uninsured persons; due to the high default rate of uninsured patients, hospitals set their rates much higher than for persons whose insurance will reimburse at a more predictable (indeed, negotiated) level and rate.

Doesn't the ambulance fee mostly have the effect of shifting the unpredictable rate of payment for services from the uninsured to the insured? Aren't the wealthy and middle-income classes already subsidizing the less-fortunate through their taxes? And isn't the fee set almost arbitrarily to a higher level to anticipate a significant percentage of defaults on payment by the indigent or low-income users?

Anonymous said...

I noticed that marc said that people will think twice about whether to cal in ambulance if they only maybe need one. He seemed to think this was a good thing. As an EMT in the county, i have seen people who have delayed calling an ambulance even without user fees because they thought they would be fine. One man waited three hours before calling us when he was having a stroke. If people are reluctant to call for an EMT in life threatening situations, how do you think it will be when there are substantial fees charged to the user? Also, you mentioned an average cost of $250. That seems off to me, given that the fee range is between $200 and $800, even if ALS service is rarely used.