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  • #16
    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.
    I would say it's definitely excessive. It's certainly more than we charge. However, you'll note in the article that the department in question gets no taxpayer dollars. They'd like to change that, but for now all they have is user fees. Hence my comment that the people don't want to pay for the service they get. They certainly don't want to pay the user fee (i.e. the excessive bill they just got), and I would bet that if you tried to float some sort of levy to pay for the service with tax dollars or property assessment that it would be voted down. You're screwed either way. I've said for a long time, only half jokingly, that what some of these communities need are more fire stations to close down and longer response times. Of course I would hate to see our colleagues lose jobs, but I sometimes wonder if it's going to take people dying for the public to really get it. If you don't want to pay what it costs to run the service, it's going to go away. Simple as that.

    Comment


    • #17
      Originally posted by palmer1121 View Post
      I agree that it is wrong to bill someone entrapped in an MVA or whos house has just burnt down.
      Why is that wrong?

      You get a bill if you have to have your gallbladder removed.
      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


      • #18
        Originally posted by ChiefKN View Post
        Why is that wrong?

        You get a bill if you have to have your gallbladder removed.
        It shouldn't be wrong, but it certainly feels wrong to me. I've always felt that we shouldn't send bills to cardiac arrest patients we don't save either. I remember feeling ill for weeks after the first SIDS case I transported, seeing the looks at the parent's faces, and realizing they were going to get a $1000 bill on top of their child just dying. I know the reality is different, but it doesn't make you feel any better, you know?

        But in the end you're right. Nobody questions getting a bill for several thousand dollars when they have to have emergency cardiac surgery. Sure, they might argue that the bill is too high, but they're certainly expecting to get one.

        Comment


        • #19
          Originally posted by ChiefKN View Post
          Why is that wrong?
          so its fair to bill the driver of a car who has a green light and gets t-boned by a guy running a red light because he's the one who used the services even though he was just driving to the grocery store and abiding by the laws?

          make the homeowner/insurance pay for the water used and any tools damaged that need to be replaced, not for the service... you cant say you wouldnt be p.o.'d if you get served with a bill from the FD for coming and saving your home.

          in my opinion its a bit late to all of a sudden start billing citizens who DEPEND on our assistance in time of need.

          there is no alternative to getting cut out of a car or having your house fire extinguished or dragging you from the building as it crumbles around you... should we start charging families of murder victims to solve the crime too?

          Comment


          • #20
            Originally posted by ridebmxnc View Post
            so its fair to bill the driver of a car who has a green light and gets t-boned by a guy running a red light because he's the one who used the services even though he was just driving to the grocery store and abiding by the laws?

            make the homeowner/insurance pay for the water used and any tools damaged that need to be replaced, not for the service... you cant say you wouldnt be p.o.'d if you get served with a bill from the FD for coming and saving your home.

            in my opinion its a bit late to all of a sudden start billing citizens who DEPEND on our assistance in time of need.

            there is no alternative to getting cut out of a car or having your house fire extinguished or dragging you from the building as it crumbles around you... should we start charging families of murder victims to solve the crime too?
            Good post !!!

            Comment


            • #21
              Originally posted by ridebmxnc View Post
              so its fair to bill the driver of a car who has a green light and gets t-boned by a guy running a red light because he's the one who used the services even though he was just driving to the grocery store and abiding by the laws?
              So, we should wait until the courts decide someone's guilt before we bill? So, let me understand this. Who is paying for your shed when a large tree branch falls and crushes it? How is it fair that you pay? You didn't cause that branch to fall.

              Or how about this one... someone drops a load of nails in the road (don't know who). You run them over and have to get four new tires. Not fair, sure. But WHO pays for that. You are a taxpayer after all! Shouldn't the state pay for that since they failed to keep the road clean? For pete's sake, you were INNOCENT! You depend on the DOT!

              Your argument relies on us making some sort of judgement over who is worthy of a bill or not... ????

              make the homeowner/insurance pay for the water used and any tools damaged that need to be replaced, not for the service... you cant say you wouldnt be p.o.'d if you get served with a bill from the FD for coming and saving your home.
              Wait, if someone saved my home I'd probably be pleased. However, I thought the thread was about EMS services.

              in my opinion its a bit late to all of a sudden start billing citizens who DEPEND on our assistance in time of need.
              We can inject emotion and drama into this discussion or we can look at the facts and be objective.

              "depend"... well, sure just like I depend on my surgeon. I still pay for that surgeon.

              there is no alternative to getting cut out of a car or having your house fire extinguished or dragging you from the building as it crumbles around you... should we start charging families of murder victims to solve the crime too?
              Last time I brought someone to the ER, they didn't pick which one. Yet they had to pay.

              You are bringing in other issues that have no relation. Again, we can have a rational discussion or introduce these non-sequitars.

              I maintain that our society has this entitlement mindset and a lack of personal responsibility. It's a damn shame.
              Last edited by ChiefKN; 09-19-2010, 09:04 AM.
              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


              • #22
                Originally posted by ChiefKN View Post
                Who is paying for your shed when a large tree branch falls and crushes it? How is it fair that you pay? You didn't cause that branch to fall.
                thats not a life or death situation, no one calls 911 for a tree falling on their shed and gets a response unless there is a person inside. a shed can wait to be fixed, or an insurance claim can be filed. being cut out of your car to recieve treatment however can not wait, and noticing unsafe tree limbs and taking care of them is part of being a responsible homeowner.
                Originally posted by ChiefKN View Post
                Or how about this one... someone drops a load of nails in the road (don't know who). You run them over and have to get four new tires. Not fair, sure. But WHO pays for that. You are a taxpayer after all! Shouldn't the state pay for that since they failed to keep the road clean? For pete's sake, you were INNOCENT! You depend on the DOT!
                Also not an emergency situation... and if its been reported and DOT fails to take care of the problem then they do owe you for the tires.
                Originally posted by ChiefKN View Post
                Your argument relies on us making some sort of judgement over who is worthy of a bill or not... ????
                no the courts need to make that decision on who is to be billed. a department isnt going to go under because of a delay in billing.
                Originally posted by ChiefKN View Post
                However, I thought the thread was about EMS services.
                its all relative, FD's are charging these days too...
                Originally posted by ChiefKN View Post
                "depend"... well, sure just like I depend on my surgeon. I still pay for that surgeon.
                lots of surgeons also write off bills for pxs... dont see to many EMS departments doing that. surgeons are also providing a much larger standard of care to a px rather than the average hour an EMS unit deals with a px (if that).
                Originally posted by ChiefKN View Post
                I maintain that our society has this entitlement mindset and a lack of personal responsibility. It's a damn shame.
                it has nothing to do with the entitlement mindset... these services have been provided forever at little to no cost to citizens and now a large number of fire and EMS departments have decided to start charging(often times unreasonable and ridiculous fees), of course people arent going to be 100% for it and ready to jump on board for things they used to get for free.

                Comment


                • #23
                  Let me know what surgeon that is... My knee was 25,000 to fix. And a much larger standard?

                  Last time I checked ACLS was the same for Medics and Doctors... they just have a nice little cushy office not the middle of a racist projects to work in.

                  You cant justify not billing someone just because "they didnt bring that mean old heart attack on them selves over the years!!" Who cares? I didn't choose mess my knee up but it still cost me 25k.

                  ChiefKN, I agree with you.

                  Comment


                  • #24
                    Billing for auto accidents is stupid. Where are the extra costs to your dept.? Trucks , you have to have them if they run or not. Equipment? Really? What pricey equipt. do you use on an MVA? Manpower if you are paid you are there anyways. You are SUPPOSED to run that MVA it's your job. If you are not paid then there is now cost there. Now say you goto said auto accident and no one gets transported, where is your cost/ A little fuel? You wouldn't mind burning that fuel for training or going to the store. bottom line is that there is no cost to a cookie cutter auto accident.

                    Comment


                    • #25
                      Originally posted by ridebmxnc View Post
                      thats not a life or death situation, no one calls 911 for a tree falling on their shed and gets a response unless there is a person inside. a shed can wait to be fixed, or an insurance claim can be filed. being cut out of your car to recieve treatment however can not wait, and noticing unsafe tree limbs and taking care of them is part of being a responsible homeowner.
                      Not all our calls are life and death. I would say that's only a very small percentage.

                      So, you would be okay with the FD/EMS billing for the non-emergency runs then?

                      Also not an emergency situation... and if its been reported and DOT fails to take care of the problem then they do owe you for the tires.
                      Good luck with that. It will not happen.

                      lots of surgeons also write off bills for pxs... dont see to many EMS departments doing that. surgeons are also providing a much larger standard of care to a px rather than the average hour an EMS unit deals with a px (if that).
                      Why does standard of care matter?

                      Also, I'm an executive in a for-profit international healthcare company. We do have procedures to write off patient balances based on their income. However, we are required to bill and we can't tell a patient that we won't attempt to collect on the invoice. The office of the inspector general gets touchy with medicare providers doing that sort of thing.

                      If a patient can prove that they don't have the means to pay, then I bet that most EMS agencies would also write it off. Why spend time and money trying to collect a bill you won't get paid on?

                      it has nothing to do with the entitlement mindset... these services have been provided forever at little to no cost to citizens and now a large number of fire and EMS departments have decided to start charging(often times unreasonable and ridiculous fees), of course people arent going to be 100% for it and ready to jump on board for things they used to get for free.
                      There has ALWAYS been a cost. The costs were just not direct costs based on the use of the services.

                      But you know what? The world is changing around you. Especially in regards to healthcare. Cities are going broke, fire and ems agencies are facing cuts. If billing can preserve safe staffing and the continuation of these vital services, then why not do it?

                      Change is tough, but it's inevitable.
                      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


                      • #26
                        Fees for Service

                        There must be a means to pay for the services you provide (fire protection, EMS, rescue, etc.).

                        While property taxes have been the major source of providing funding for some of these services, sometimes this does not cover all the costs. Billing the insurance company, user fees and the like are often used to help pay for the services.

                        While no one wants to send a bill for someone in need, it is part of the business. If your agency runs out of funding, do you close it? Fire protection and EMS are 24/7 services. We cannot shut down when all the yearly property tax funding is used up. Revenue needs to be obtained to run 24/7/365.

                        Since there are 50 states, each state probably has different statutes on how taxpayers can be assessed for taxes for fire protection and EMS services. Also, throw in the Medicare Program regulations.

                        While we would like to provide our needed services for free, that is not possible. The vehicles/trucks, personnel and equipment that your entity has to provide the service, needs to be purchased and that costs money.

                        Comment


                        • #27
                          Originally posted by FireFuss
                          EMS hasn't done anything but what it HAS to. There used to be a time where you would pull up on a guy that says "my tummy hurts" and you'd say SO TAKE SOME PEPTO, why'd you call us?!

                          Nowadays if you don't take the guy complaining of a headache to the ER he will sue you. The biggest problem with EMS abuse wasn't allowed to happen by any EMS providers or systems. It started getting worse and worse, more and more abused over time until it ended up where it is now. These people are so entitled and expect everyone else to take care of what they need. The day a guy calls you out to a payphone ONE BLOCK from the hospital for a cold, and you tell him to walk the one block, is the day you lose your job. WHY?

                          It's the same mentality I deal with all the time in the squad. I just finished a 4 day tour in the squad(ambulance) that we have to do every 3-4 months. The people with ACTUAL emergencies, few and far between as they are, don't expect anything. We do all we can for them. But the gitbags we pick up on the side of the road for a nosebleed, or fever or whatever else EXPECT the ambulance to take them to the ER. They also get so ****ed when the charge nurse says "triage". I love rolling these guys in on a wheelchair right past the ER to triage and watching them say BUT I CAME ON AN AMBULANCE! That's where I'm usually like, I KNOW... The guy we brought in just before you with the gunshot to his back got right in, I wonder why they don't think your (insert sickness here) isn't JUST as much of an emergency!!
                          .
                          Have any idiots get up and walk out on you yet after you take them to triage? :-p

                          Comment


                          • #28
                            Originally posted by ridebmxnc View Post
                            make the homeowner/insurance pay for the water used and any tools damaged that need to be replaced, not for the service... you cant say you wouldnt be p.o.'d if you get served with a bill from the FD for coming and saving your home.
                            Good luck with that one. Would you allow homeowners to refuse your assistance? How dare you show up and spray water and use tools without their consent. What if a neighbor was the one who called in the fire, would you charge the person requesting your assistance, or the homeowner. Could the homeowner then sue the neighbor for those expenses?

                            Talk about a can of worms.

                            Comment


                            • #29
                              Originally posted by mcwops View Post
                              Good luck with that one. Would you allow homeowners to refuse your assistance? How dare you show up and spray water and use tools without their consent. What if a neighbor was the one who called in the fire, would you charge the person requesting your assistance, or the homeowner. Could the homeowner then sue the neighbor for those expenses?

                              Talk about a can of worms.
                              We get that all the time with the ambulance. A patient gets a bill and then refuses to pay, stating that they didn't request us (blaming a bystander, family member, etc).

                              Comment


                              • #30
                                Originally posted by tree68 View Post
                                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.
                                .
                                A myth that ER have become primary care.

                                http://www.slate.com/id/2247051/?from=rss
                                Last edited by neiowa; 09-20-2010, 12:24 PM.

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