Billing and 911

[Alas]

San Francisco, California. Patient requests for an ambulance via 911, Engine and Private company arrives. Walks down stairs and into ambulance, gets blood pressure, blood glucose, and 4 lead. Patient feels significantly better, and signs an 'against medical advice', and walks back home. No transport was done.

Patient was billed 400 dollars 2 days later by private company. Patient was unaware they would be billed, refused transport and believed they should not have been billed.
Comments?

Thank you,
Alas

 

[dstevens58]

Depends on the agreement between city and private EMS (if one exists).

I would also think that somewhere (in the fine print) when the patient signed out AMA, there would be something that they (or their insurance) would be billed for the response.

 

[Shishkabob]

A service was provided. Units were taken out of service for a length of time, unavailable to other callers. Equipment was used. Gas was used. Personnel time was used.

 

[exodus]

They were offered a service by accepting treatment, if they refused treatment, then they wouldn't be billed.

 

[usalsfyre]

Last time I checked you can't check into an ED, receive an assessment, sign out AMA, and not expect a bill. Why is EMS any different?

 

[BF2BC EMT]

A service was provided. Units were taken out of service for a length of time, unavailable to other callers. Equipment was used. Gas was used. Personnel time was used.

Agree.

Edit- If these types of charges aren't included there would be even more abuse in EMS, everyone would call if they didn't feel well and after getting a quick look over saying they're fine would leave AMA, running crews into the ground.

Only time I can see you not being charged is if through taxes you pay for the system. Might be wrong though

 

[Tigger]

Vitals, a BGL, and a 4-lead definitely constitute an assessment and are thus billable. No "treatment" needs to be administered to constitute a billable service.

 

[Handsome Robb]

A service was provided. Units were taken out of service for a length of time, unavailable to other callers. Equipment was used. Gas was used. Personnel time was used.

This.

 

[PotatoMedic]

Nice thing about signing an AMA is that insurance wont cover it. And like others have said. They came, they saw, and you refused to go with them AFTER they did a few tests and checked you over.

 

[Simusid]

If we don't transport we don't bill.

I don't know if that is per our internal policy or per an agreement with the town but that is what we do.

 

[medicdan]

I know Medicare/Medicaid won't reimburse non-transports... the billing codes are based on the level of service provided and the miles (if/when you turn a wheel). I'll need to go into the CMS codes, though, to find it.
Private insurance... I don't know. My guess is that the company can bill for whatever they want... knowing that insurance won't pay, but a naive patient might...
Most ambulance services write this off as the cost of doing business, or as a tax deduction (uncollected care).

 

[MMiz]

It really depends on the jurisdiction and service. Working for a private service, we billed if we made contact and provided services on a 911 call.

Every medical provider I've ever been to charged for any patient contact. My doctor didn't waive my bill because I didn't have Strep throat, nor did my dentist waive the bill the time I went in with a mystery tooth ache that was throbbing.

The challenge with EMS is that the bill is so astronomically high compared to the level of service the public perceives we provide.

 

[looker]

Each town have own rules on this but it get interesting. Medicare/medi-cal(medicaid) will not pay for non transport. If person have private insurance and rendering provider is contracted they will get denied for it. Being they are provider for insurance they accept authorized payment in full in this case 0 and can't bill anything more for it. They can't turn around and bill the patient being insurance didn't authorize it. Basically if town permits billing for service provided and person do not have any insurance or one that amb do not accept they are screwed.

 

[looker]

It really depends on the jurisdiction and service. Working for a private service, we billed if we made contact and provided services on a 911 call.

Every medical provider I've ever been to charged for any patient contact. My doctor didn't waive my bill because I didn't have Strep throat, nor did my dentist waive the bill the time I went in with a mystery tooth ache that was throbbing.

The challenge with EMS is that the bill is so astronomically high compared to the level of service the public perceives we provide.

That example is totally different compare to amb and non transport. You were given exam by both doctors for which insurance will reimburse. That is not the case with amb and non transport.

 

[STXmedic]

That example is totally different compare to amb and non transport. You were given exam by both doctors for which insurance will reimburse. That is not the case with amb and non transport.

Are you not given an exam by the medic?

 

[Anjel]

we bill $150 for a refusal.

 

[looker]

Are you not given an exam by the medic?

Yes but insurance company/ medi-cal(medicaid)/medicare do not see medic being equal to md doc.

 

[DesertMedic66]

I've heard that my company only charges if you get transported. However I am unaware if that is true or not. And I honestly don't care about billing because it's not my job to bill. I collect insurance info when I can because that is part of my job. But what we charge and don't charge for doesn't effect how I do my job.

 

[MMiz]

Yes but insurance company/ medi-cal(medicaid)/medicare do not see medic being equal to md doc.

Either way someone ends up paying. In the case of a private service, generally it's a pay-for-service model. Generally a private service's only source of income is from patients, so it makes sense that you pay for the service you use.

I've sat on a street corner for 12 hours with a partner for a call, only to have it be a diabetic refusal. My services and supplies weren't free. The $80,000 ambulance I drive costs money, as does the $75 in gas, $10 for dispatch, and $5 in supplies that was spent on the call. Our total wages of $400 or so for the shift certainly weren't free.

Police and fire service are generally free because people pay for it with their tax money. People don't want to pay for EMS with their tax money, and complain even more when they get the bill.

 

[Handsome Robb]

And I honestly don't care about billing because it's not my job to bill. I collect insurance info when I can because that is part of my job. But what we charge and don't charge for doesn't effect how I do my job.

Agreed :excl: