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  • People who don't want to pay for our services

    http://www.registerguard.com/csp/cms...ugene-fire.csp

    This link was on another journal's website today. It struck home with me because I recently received an angry letter from a former patient saying that we were trying to rob her with the ambulance bill we sent her and that we should be ashamed of ourselves. Our billing rates are purposely set at what the other ambulance services/departments in the state charge so people can't claim we charge more than anyone else.

    I really don't know what people expect us to do. Our fire department as a whole continuously runs in the red when you do straight comparisons between expenditures and revenue, as I would imagine many departments do who run EMS and have an all paid staff. Our annual O&M is 3 million while our ambulance revenue (the only revenue of any substance we have) comes in at just over 1 million. I'm under constant pressure from the council to think of innovative ways to make more money. Raise ambulance rates when possible, start charging for various permits, plus they want me to come up with a plan to charge for fire response (shudder). They'll admit (off the record) that they understand we'll probably never make a profit, but they want to make as big a dent in the red as possible.

    It's a common theme these days. People want to have you at their doorstep in 3 minutes when they're having chest pain, but they don't want to pay for it. Frustrating.

  • #2
    While you'll never make everyone happy, it's a public education issue. The public has to know what kind of services they're getting, how it's paid for, and what will happen if the City can't pay for it.

    It's a hard sell sometimes, but pub-ed is the only way to reach them.

    Comment


    • #3
      We have a group currently trying to meld three volunteer fire department ambulance squads into one not-for-profit independent. Which will bill for services, something the FD ambulances not only didn't, but legally couldn't.

      There are those who are upset, especially since the new squad has informed the townships involved that a contribution commensurate with their call load for the previous year will be expected. Two townships see it as a bargain. The third is hesitant, but will probably come around.
      Opinions my own. Standard disclaimers apply.

      Everyone goes home. Safety begins with you.

      Comment


      • #4
        Thats why I love working in the ghetto...

        If you make people angry on a call they either don't have a phone to call... or overdose before they remember to do it.

        Comment


        • #5
          Originally posted by roykirk1989 View Post
          http://www.registerguard.com/csp/cms...ugene-fire.csp

          This link was on another journal's website today. It struck home with me because I recently received an angry letter from a former patient saying that we were trying to rob her with the ambulance bill we sent her and that we should be ashamed of ourselves. Our billing rates are purposely set at what the other ambulance services/departments in the state charge so people can't claim we charge more than anyone else.

          I really don't know what people expect us to do. Our fire department as a whole continuously runs in the red when you do straight comparisons between expenditures and revenue, as I would imagine many departments do who run EMS and have an all paid staff. Our annual O&M is 3 million while our ambulance revenue (the only revenue of any substance we have) comes in at just over 1 million. I'm under constant pressure from the council to think of innovative ways to make more money. Raise ambulance rates when possible, start charging for various permits, plus they want me to come up with a plan to charge for fire response (shudder). They'll admit (off the record) that they understand we'll probably never make a profit, but they want to make as big a dent in the red as possible.

          It's a common theme these days. People want to have you at their doorstep in 3 minutes when they're having chest pain, but they don't want to pay for it. Frustrating.
          So I guess you don't think a non-emergency transport of $1600.00 plus $20.00/mile is excessive. Pretty expensive taxi ride if you ask me.

          All emergency services should be paid by tax dollars... not user fees... period.

          Comment


          • #6
            Originally posted by don120 View Post
            So I guess you don't think a non-emergency transport of $1600.00 plus $20.00/mile is excessive. Pretty expensive taxi ride if you ask me.

            All emergency services should be paid by tax dollars... not user fees... period.
            Actually, using an ambulance like a taxi should result in a fee. There should be no non-emergent transports.

            Period.
            Logic and proportion have fallen sloppy dead.

            Comment


            • #7
              Originally posted by johnny46 View Post
              Actually, using an ambulance like a taxi should result in a fee. There should be no non-emergent transports.

              Period.
              Well now you guys are opening a can of worms...

              If people would vote "yes" on levy's there would be no need for EMS billing.. but the truth is most people (especially those in wealthy areas) don't call 9-1-1 much if ever at all.

              We have forms for "alternative transport" that we may present to a patient if its a true BS run (something stupid like a hangnail) where the form has a list of cab's and private EMS companies with their contact info. It's a lot of paper work... and really isn't worth the liability so most people don't even bother with it

              But I do agree 1600 for a non ER ride to the hospital is a little crazy..

              ...I believe we charge about 400 for a BLS tx and 950 for an ALS tx.

              I think that department should get with other departments in the metro area.. talk to the hospitals.. and come up with a drug exchange program in order to cut the cost of drugs to a bare minimum thus reducing transport costs..

              Comment


              • #8
                Originally posted by BW21 View Post
                Well now you guys are opening a can of worms...

                If people would vote "yes" on levy's there would be no need for EMS billing.. but the truth is most people (especially those in wealthy areas) don't call 9-1-1 much if ever at all.

                We have forms for "alternative transport" that we may present to a patient if its a true BS run (something stupid like a hangnail) where the form has a list of cab's and private EMS companies with their contact info. It's a lot of paper work... and really isn't worth the liability so most people don't even bother with it

                But I do agree 1600 for a non ER ride to the hospital is a little crazy..

                ...I believe we charge about 400 for a BLS tx and 950 for an ALS tx.

                I think that department should get with other departments in the metro area.. talk to the hospitals.. and come up with a drug exchange program in order to cut the cost of drugs to a bare minimum thus reducing transport costs..
                We already have a drug exchange program with the hospitals, including taking stuff that will expire in the not-too-distant future off our hands in exchange for current stuff.

                This whole thing speaks to a much larger issue - ERs are the primary health care source for too many people. There was a day that every "home town" had a doctor in residence who did office hours and housecalls. That no longer exists. Today the ER is the family doctor, and the ambulance is how you get there.

                We just bumped our rates up for the first time in about three years. We try to keep them in the ballpark of those around us, with a nod to what Medicare/Medicaid will pay.

                Average transport distance for us is around 20-25 miles - still a pretty good chunk of change at even $10 a mile, and when added to a base rate in the range of $700.

                Even with that, we really need that subsidy from the townships.
                Opinions my own. Standard disclaimers apply.

                Everyone goes home. Safety begins with you.

                Comment


                • #9
                  Originally posted by tree68 View Post
                  This whole thing speaks to a much larger issue - ERs are the primary health care source for too many people. There was a day that every "home town" had a doctor in residence who did office hours and housecalls. That no longer exists. Today the ER is the family doctor, and the ambulance is how you get there.
                  I worked at jobs without health insurance. I went to a clinic and paid around 35 dollars for a visit and a shot if I needed one. So the ER thing is bull****. That's a choice. And if you need healthcare on a regular basis and there isn't a clinic, then MOVE.

                  Life's tough. People cross the ocean in homemade boats--it's not too much to ask for "poor" Americans to move a few miles to be close to clinics.
                  Logic and proportion have fallen sloppy dead.

                  Comment


                  • #10
                    Originally posted by johnny46 View Post
                    I worked at jobs without health insurance. I went to a clinic and paid around 35 dollars for a visit and a shot if I needed one. So the ER thing is bull****. That's a choice. And if you need healthcare on a regular basis and there isn't a clinic, then MOVE.

                    Life's tough. People cross the ocean in homemade boats--it's not too much to ask for "poor" Americans to move a few miles to be close to clinics.
                    You do have to admit that some people are not capable of taking care of themselves.... either by choice or circumstance. Others just want someone else to take care of them or make decisions for them.



                    That whole survival of the fittest thing might have had some value after all.



                    If you don't go out and chop some wood for the fire, trap or shoot game for food, walk down to the stream and collect water, right after you make a water bag from the entrails of a goat, you're going to die.

                    Put a little effort into your life people, come on.
                    HAVE PLAN.............WILL TRAVEL

                    Comment


                    • #11
                      Originally posted by johnny46 View Post
                      I worked at jobs without health insurance. I went to a clinic and paid around 35 dollars for a visit and a shot if I needed one. So the ER thing is bull****. That's a choice. And if you need healthcare on a regular basis and there isn't a clinic, then MOVE.

                      Life's tough. People cross the ocean in homemade boats--it's not too much to ask for "poor" Americans to move a few miles to be close to clinics.
                      Its not so much the point that there arent enough doctors, but that people dont think they have to go to them and instead call an ambulance for everything from a full blown cardiac arrest to a tooth ache. There needs to be a point where providers simply start saying no, to the stupid calls. That tooth ache transport can cause a delay in service to an individual in cardiac arrest who actually needs ems. EMS has allowed itself to become a taxi to the hospital rather than being an Emergency Medical System for to much of America's population.

                      The county i dispatch for as implemented an Advanced Practice Paramedic program to do wellfare checks and drastically reduced the amount of people who regularly abuse the system and then cant pay for the services rendered, causing the drastic budget problems. We still charge for calls, but the rates arent enough to put anybody in the poor house.

                      Our county wide EMS system actually just expanded and took over a private ambulance service that ran calls in that part of the county for them.

                      As far as paying for fire services, unless its an ongoing problem with false alarms coming (fine the company/resident), i dont agree with it unless there is significant damage to the departments tools/equipment. Charging someone to cut them out of a car (at the ridiculous rates some departments do) is inexcusable in my opinion, or saving someones house from burning to the ground and adding yet another bill on top of replacing everything in their entire lives because insurance never covers it all.

                      Comment


                      • #12
                        I agree with the posts that say that people should be denied a run for a non-emergency reason... here's the problem.

                        There is very little legal protection for a provider to do that.

                        As for people not appreciating or wanting something for nothing... well, that's our American self entitlement mindset. I deserve it because "....insert reason here...". Usually its because "I pay taxes" (when they probably don't, or pay pennies on the dollar they actually utilize).

                        Our culture has morphed over the last fifty years, and its sad.
                        I am now a past chief and the views, opinions, and comments are mine and mine alone. I do not speak for any department or in any official capacity. Although, they would be smart to listen to me.

                        "The last thing I want to do is hurt you. But it's still on the list."

                        "When tempted to fight fire with fire, remember that the Fire Department usually uses water."

                        Comment


                        • #13
                          Originally posted by ChiefKN View Post

                          Our culture has morphed over the last fifty years, and its sad.
                          AMEN TO THAT!

                          i'm only 23, but i am not a big fan of the weak mindedness and dependence upon others most of America has developed...

                          Comment


                          • #14
                            Billing for Fire Response

                            Two departments I currently work part time for bill for Fire and MVA response. However, the individual, whether in an MVA or homeowner victim to a house fire are not billed. The insurance company is billed. No insurance= No bill. Insurance companies have money alloted to pay for our services. I agree that it is wrong to bill someone entrapped in an MVA or whos house has just burnt down. But the insurance companies pay, not the taxpayer/victim. While it will never totally recover our costs of providing services it does recoup some cost and possibly allow for purchase of new equipment or apparatus.

                            http://www.ersbilling.com/ this is the company used. I am not promoting them or suggesting using them in any way. Just passing along what I know.

                            Comment


                            • #15
                              Originally posted by palmer1121 View Post
                              No insurance= No bill.
                              Good way to get in trouble in NYS, especially in the ambulance business. Either you bill everybody the same (ie, according to the same fee schedule), or you bill no one. There is no "soft billing."

                              A number of ambulance services in NY were recently taken to task for "membership programs" in which a member would have whatever costs their insurance didn't cover forgiven/written off, resulting in no out-of-pocket expense beyond the "membership fee."

                              NY feels that this is offering a form of insurance without the appropriate license.
                              Opinions my own. Standard disclaimers apply.

                              Everyone goes home. Safety begins with you.

                              Comment

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