# pt has no complaints....



## KEVD18 (Jun 30, 2005)

you witness an mva. compact car rearends a full size pickup at at least 40mph. +air bag deployment, +deformity to vehicle, +seatbelt use. -loc, -head trauma. pt denies c/p. sob, d/n/v. pt's only complaint is a small amt, 3/10 of lover back pain. p.e. is completely unremarkabel in all respects.

do you transport this pt? in ma, there is a significant moi. as long at the pt doesnt refuse care, every effort should be made to transport this pt. it is the same for you all? do er's know about htis???

the reason i ask is becuase i had this sit tuesday. when i brought the pt to the er, i delivered my report to the recieving nurse. i got to the part about "the pt has no significant complaints" and the nurse gave me a ration of sh*t. "well if he has no compalint, whyt is he here. were very busy you know. let him wait in the waiting room(meanwhile, the pt is in full spinal prec). the whole thing just really aggravated me

/rant off


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## Wingnut (Jul 1, 2005)

Well as far as our county goes, that is a definite transport, the MOI alone dictates that we'd have to. The only way that pt would not be going is by signing a refusal.


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## Stevo (Jul 1, 2005)

what if s/he wants to go, say _'for insurance reasons' _, and has no complaints ?


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## Chimpie (Jul 1, 2005)

> _Originally posted by KEVD18_@Jun 30 2005, 11:46 PM
> * i got to the part about "the pt has no significant complaints" and the nurse gave me a ration of sh*t. *


 That's where I would have written that the pt complained of lower back pain - 3/10.  

Let me ask this:  In your words, why did you transport?


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## KEVD18 (Jul 1, 2005)

well, i guess i need to mention that the pt's back pain didnt show up until interviewed by the er nurse(convienent how that works huh?)

i transported the pt due to a significant moi. the amt of damage to the vehicle, speed of the crash(remember i witnessed the accident) airbag deployment and what not. all this put together suggests that there is injury. the pt may not know it yet, due to the fact that his adrenaline is still running and he probably cant feel pain the same way as he would straight.

i know i was right in transporting. i just dont like the response i got from the er......


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## Chimpie (Jul 1, 2005)

Good.  Taking with what you saw, what you know about what kind of injuries can be caused in something like that, and with the information that was given to you by the pt., do you think you could have written something else down?


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## Jon (Jul 1, 2005)

in PA, "significan MOI" is enough for a trauma alert, even a flight.

Jon


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## Stevo (Jul 1, 2005)

radiologists , imho, owe the brunt of thier biz to ems. we bring in people fully immobilized because they wish to _'get checked out' _ whom they tend to that have no complaint. 

this is due to lack of a rule out most localities have. Some states, like Maine for instance actually allow ems to rule out low moi incidents. Canada does also iirc...

they realized  a decline in the overall costs in the system due to this, and yes there may be some adrenaline masking incidents that slip through the cracks in it, yet _defensive medicine_ only serves as a cya, not the patient

how many people have i hurt with backboards over our old roads ? gawd only knows, studies for pressure necrosis 12,24,48 hrs after reveal the only injury was what WE introduced to the patient

ems is not for the weak is it? nor should it be _goverened _by such sorts, imho they should allow us to refuse a non-complaint patient and should dream up whatever protocall is necessary to do so

they should also allow us to declare death other than the head being seperated from the body by more than 3 feet, as i'm sick of flogging corpses for the family's viewing pleasure

AND WHILE WE'RE AT IT, i'm not a freakin' taxi driver either. i counted 9 people in our rig once! we even had thier luggage! holy saviour on a stick, do i need a hat license?

~S~


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## KEVD18 (Jul 1, 2005)

i was just5 irked that the er nurse was busting my balls for bringing in a pt the had no sig. complaints. i SAW the wreck. this perwson needed to be checked out. end of story. just would have been nice if the er staff picked up on this.......


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## Stevo (Jul 1, 2005)

sure KEVD18,
i would be too, and hey you and i are just doing our job right?

we've had very similar incidents at our er with a certian snitty old nurse who's face would crack up and fall off if she smiled...

many times we bring in our frequent flyers, and all they really are is lonely, no valid (allbeit sponsoring soaring stocks in Pitzer) complaints...

so if some er staff doesn't like it, then why don't thier nurses unions confront JACHO for standards allowing them to rule out these sorts, and heave them back in our rigs?

after all, admissions takes what kind of $$$$ ? , or maybe it's ommissions that account for more $$$$ ?

~S~


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## Ridryder911 (Jul 1, 2005)

Simply stating per patient request, should have been signficant enough, with a brief description of MOI. I am sure this is not the first or last she has seen that night, that wants to be r/o for injuries for insurance reasons.

She should know as well as ER, we have to "play the game" & evualuate all that request. 

Be safe, 
Ridryder 911


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## TTLWHKR (Jul 1, 2005)

Since you cannot deny transport, as that would constitute abandonment; transport for the hell of it. Patients can have very serious injuries and have little or no pain. I had a guy from an MVA w/ a C-Spine injury similar to a "hangman's fracture". He only had pain in his left hand...

What can it hurt to transport? That's what we're here for anyway.


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## Stevo (Jul 2, 2005)

if we introduce unnecessary costs, are we part of the _solution_, or _problem_ fellas?



> *The World Health Organization "ranked the countries of the world in terms of overall health performance, and the U.S. [was]...37th." In the fairness of health care, we're 54th. "The irony is that the United States spends more per capita for health care than any other nation in the world" (The European Dream, pp.79-80). Pay more, get lots, lots less.
> 
> "The U.S. and South Africa are the only two developed countries in the world that do not provide health care for all their citizens" (The European Dream, p.80). Excuse me, but since when is South Africa a "developed" country? Anyway, that's the company we're keeping.
> 
> ...



~S~


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## vtemti (Jul 2, 2005)

> _Originally posted by TTLWHKR_@Jul 1 2005, 10:48 PM
> * Since you cannot deny transport, as that would constitute abandonment; transport for the hell of it. Patients can have very serious injuries and have little or no pain. I had a guy from an MVA w/ a C-Spine injury similar to a "hangman's fracture". He only had pain in his left hand...
> 
> What can it hurt to transport? That's what we're here for anyway. *


 The "wacker" is right, are we not obligated by law to transport if called and the patient does not refuse? In fact, I always strongly suggest being checked out even if the patient has no CC, especially when the MOI suggest a possiblity of serious injuries. Remember also, that when the adrenaline is pumping full throttle, many symptoms can be easily covered. 

It is technically not our job to diagnose nor do we have the "Big Toys" to correctly do it with so, don't let a comment like that get to you. Be happy with knowing that you did the right thing.


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## Stevo (Jul 2, 2005)

i read a good jems article a while ago about refusals ALL being AMA , because they had the potential to backfire on a crew, so i've slipped it in ever since.

yet this non diagnostic operatus modi  is really a copout. Note the latest Itech cric utilizes diagnostic based assessments we were taught years ago then told to forget
_(until they dug it up again, and presto! a whole new set of old ems books with new covers)_

see, they tried to_ dumb down_ ems, but it didn't work.....

assessment _IS_ diagnostic, that's why we work suspected MI's, and if you didn't work the angle that presented as the most suspicious nurse Crachet is gonna get ugly on you isn't she?

yet if there's no injury, we've gotta assume one? dream on up? 

let's put it another way (this has happened to me countless times) 10-50I patient w/o complaints stated or found, feneder bender , low moi, wishes transport to hospital BECAUSE S/HE NEEDS A FRIGGIN' RIDE!

what does your crew do? charge per mile?

~S~


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## TTLWHKR (Jul 2, 2005)

We charged a base fee for:

Responding to the run, and "gathering the patient"  :blink: 

and then a certain fee per mile to the hospital

There was an even higher fee for non-emerg. transports + the mileage fee (to stop people from calling for transports)

The 'new' protocols in the Commonwealth of PA state that if the patient does not -physically- call 911 by themselves for assistance, then they do not have to sign a refusal - as they did not request EMS. It also frees EMS of any wrong doing if they refuse to sign, as long as the attendant DOCUMENTS why they would not sign. Always good to have a LEO witness for you.


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## Stevo (Jul 2, 2005)

> *The 'new' protocols in the Commonwealth of PA state that if the patient does not -physically- call 911 by themselves for assistance, then they do not have to sign a refusal - as they did not request EMS*



PA has a brain....

Here i've chased people down the street (involved in multiple car wrecks) to sign refusals

methinks it's true what Frank Zappa said, *'The world will end in paperwork"*


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## Flight-LP (Jul 2, 2005)

Awww, the age old battle between EMS and the ER. Bottom line is if the patient wants to go, they are transported. If an ER nurse has an issue with that, the should reconsider their career options. A truly good nurse is there for the patient, regardless of their complaint or lack of................................


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## Jon (Jul 5, 2005)

> _Originally posted by Stevo_@Jul 2 2005, 11:09 AM
> *
> PA has a brain.... *


 WHAT!!!!

please share what you are somking with the rest of the fourm, Cheech!

Jon


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## Jon (Jul 5, 2005)

This weekend, I got to play mini-ER with my P-school medical director with my Event EMS orginization. Had a Refusal AMA for pt. who presented with weakness and sudden onset SOB. Pt stated condition improved, but also conplained of chest palpitations.

one 12-lead later, we found a rightward-shifted axis, no other ectopy. Gee, what is a rightward shifted axis indicitive of?





When you remember the sudden onset SOB with no PMH?

















can you say PE????



Pt. was in TOTAL denial, and refused, even with Doc and Nurse telling her to go.





Remember, though, that some refusals are stupid, and I hate getting refusals at an MVA that was called in by a passer-by with "unknown injuries."

I do the "are you hurt?""Do you want to go to the hospital?" if I get No and No, and there is no "Trauma criteria" damage, restraints were reasonably used, and pt. is not obviously intoxicated / high. I will go availibe, no services required. Also, PD is usually onscene.



Jon


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## 911 DJ (Jul 5, 2005)

Documentation is the key. Our department policy is transport ALL who wish to be transported. If we feel that a transport is medically UNnecessary, we document that & have the pt. sign a form agreeing (sp?) to pay for the trip when the insurance (or lack thereof) kicks the bill back to them.

As far as the nurse goes.... I used to carry a bottle of Midol for just such an occasion. Nurses (male or female) don't like it when a male EMT offers the Midol.  B)


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## Jon (Jul 6, 2005)

Nah... you don't know this guy... great provider, very knowlegable....


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## asys007 (Jul 7, 2005)

Since when do patients not have to sign refusals??? And for that matter, why does it matter who actually called 911? 
Where I work, all patients who are not transported must sign a refusal...this includes 'lift assists', MVCs with no injuries, and walk-ins at our station. In other words, unless you find a call with no people...a refusal must be completed. Furthermore, medical command should to be contacted even for the most minor of complaints. There is a rather lengthy list is criteria on our forms...

Bottom line, not obtaining a refusal is opening yourself and your agency to a huge liability. In my opinion, my certification isn't worth skipping 20 minutes of paperwork and a simple phone call...


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## TTLWHKR (Jul 7, 2005)

> _Originally posted by MedicStudentJon_@Jul 5 2005, 04:19 PM
> * presented with weakness and sudden onset SOB. Pt stated condition improved, but also conplained of chest palpitations.
> 
> *


 I had that a few years ago, same symptoms, except I had severe pain in both hands. I dropped to my knees when the SOB hit me, never experienced anything like that before. My heart was pounding, heart rate irregular, Hit me suddenly, no warning... Made me nauseated, I vomited repeatedly for three hours. Very bad day.

The only explainable cause was:

I was bitten by a spider, didn't do anything for like five hours, then I bumped my leg where the bite was and w/ in five minutes I was on the floor. 

Epi & Benadryl IM and some O2 and I was fine.

 :blink:


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## Stevo (Jul 7, 2005)

> *Since when do patients not have to sign refusals??? *



when they're NOT a patient for starters....of course there's always a good _nazi-emser_ that'll harass anyone even rubbernecking for a signature right?

~S~


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## TTLWHKR (Jul 7, 2005)

> _Originally posted by asys007_@Jul 7 2005, 01:04 AM
> * Since when do patients not have to sign refusals??? *


Because ambulances in South East PA were accused of Insurance Fraud. They were billing for refusals.

So the state made it so that if you want to seek treatment, you can. If you call, then you are the patient. If an adult calls for a child, the child is the patient. If someone is not capable of making the decision, they are still a patient. BUT if someone was rear-ended, and the people in one car claim injury, but not the other. You can't make the other group sign anything. Document that they refused to sign, etc; and have a witness sign. I prefer a SP officer. 

Another reason is over use of 911. Two cars bump on car pool lane of TP-476, minor scratch on the paint, 4 people in each vehicle. Both vehicles are drivable, the State Police do not respond when vehicles are able to be driven and there is no ETOH involved. Do you send Two Engines, a Rescue, and ambulances for every patient to get refusals from everyone in both cars? 

Isn't that the same as 911 abuse, sending ambulances out like Taxi Cabs, keeping them from the people who may really need it?


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## Ridryder911 (Jul 8, 2005)

Yes, we do respond. Is it abuse of EMS because you respond ?. Maybe arriving officers can see no one is injured & cancell EMS. 
Just because the state had unprofessional managers with excessive greed & poor ethics, should the emergency services not respond ? Sounds like they should had punished, & corrected the source of the problem.

How many accidents have you responded to, that patients needed to be tx & evaluated not knowing the risks involved ?  Yes, paperwork can be a pain in the butt, yet again "are the patients there for us ... or .. are we there for the patients ?

I have been an expert witness against medics who did not adequately inform patients of the risks & potential injuries... & then later did have injuries. The medics were more worried of either going to the next "big one" .. or getting offf shift on time"....not realizing they missed the "big one"..

Be safe, 
Ridryder 911


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## Jon (Jul 8, 2005)

> _Originally posted by Stevo_@Jul 7 2005, 05:01 PM
> *
> 
> 
> ...


 Yeah... why? If they are not hurt, and I don't think they need medical attention, why am I having them sign that they are refusing medical attention AGAINST MEDICAL ADVICE????


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## Stevo (Jul 8, 2005)

ok....

so , seems we have the risk anaylisis/cost benifit camp, and the liability camp of people

still no patient advocates.... 

gee, what do we do this for?

~S~


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## Jon (Jul 8, 2005)

> _Originally posted by Stevo_@Jul 8 2005, 05:33 PM
> * ok....
> 
> so , seems we have the risk anaylisis/cost benifit camp, and the liability camp of people
> ...


I'm advocating for the pt....... I'm not harassing the pt. by making someone a pt. who doesn't need to be.

Even If I'm clearing an MVC as "no services needed" if I speak with any of the involved parties and they deny both complaints and transport, I advise them that they can be evaluated by us by calling 911, or speaking with any of the LEO's onscene.

Jon


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## Stevo (Jul 8, 2005)

some good replys here fellas.....and no Jon, your not doing anything wrong

the system obviously isn't universal is it ?

~S~


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## Jon (Jul 8, 2005)

> _Originally posted by Stevo_@Jul 8 2005, 06:44 PM
> * no Jon, your not doing anything wrong
> *


 I'm priniting that out and framing it....


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## TTLWHKR (Jul 8, 2005)

> _Originally posted by MedicStudentJon+Jul 8 2005, 06:01 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (MedicStudentJon @ Jul 8 2005, 06:01 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-Stevo_@Jul 8 2005, 06:44 PM
> * no Jon, your not doing anything wrong
> *


I'm priniting that out and framing it.... [/b][/quote]
 Don't be so hard on yourself baby medic.

Maybe we can get you a star of life pacifier.

My wife bought a thermometer pacifier for her whacker bag... She got it from a pacifier catalog... a whole catalog full of pacifiers. We started getting all these baby catalogs. I asked what they were for, and she said "Guess". Why hell, the last time we were going to have a baby, she took me to Baskin Robbins and told me with an ice cream cake with a baby on it. But either way, it was happy news. Even though it will be a 21st century baby. Expensive baby, that is.


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## Wingnut (Jul 9, 2005)

CONGRATULATIONS!!!!!!!!!!!!!!!


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## vtemti (Jul 9, 2005)

> _Originally posted by asys007_@Jul 7 2005, 02:04 AM
> * Bottom line, not obtaining a refusal is opening yourself and your agency to a huge liability. In my opinion, my certification isn't worth skipping 20 minutes of paperwork and a simple phone call... *


 I agree, but remember that any refusal is only as good as the documentation that backs it. If a patient does decide to go back on EMS and gets a good lawyer, anything can be picked apart to make your life miserable.


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## Jon (Jul 9, 2005)

Congrats, Alex.... Are you really going to name him Epi????


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## TTLWHKR (Jul 9, 2005)

> _Originally posted by MedicStudentJon_@Jul 9 2005, 12:54 PM
> * Congrats, Alex.... Are you really going to name him Epi???? *


 I don't think so...


But when you have a kid, knock yourself out.


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## vtemti (Jul 10, 2005)

> _Originally posted by TTLWHKR_@Jul 9 2005, 04:20 PM
> * knock yourself out. *


 I think he already has or has tried a few times. :blink:


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## Jon (Jul 10, 2005)

> _Originally posted by TTLWHKR+Jul 9 2005, 04:20 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (TTLWHKR @ Jul 9 2005, 04:20 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-MedicStudentJon_@Jul 9 2005, 12:54 PM
> * Congrats, Alex.... Are you really going to name him Epi???? *


I don't think so...


But when you have a kid, knock yourself out. [/b][/quote]
 So I should name my kid Diprovan?


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## asys007 (Jul 28, 2005)

At our service, a 'refusal' doesn't necessarily mean that you are refusing treatment/transport against medical advice. It simply means thats you are refusing treatment and/or transport. Basically, we came and saw, we did not abandon or neglect you. By signing, you acknowledge this fact. 

As far as documentation goes, I agree that a refusal is only as good as the documentation that supports it. ALL of my charts, including refusals, include documentation of what did/did not happen. Everything is written there, down to the patient's belongings. 

And yes, I do get signatures from all patients who are able to sign. And yes, this does include refusals...who do by the way sign billing cards because they are billed for our services.


Also, for people so against 'personal attacks', you were pretty quick to call me a 'nazi-emser'....thanks ever so much.


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## TTLWHKR (Jul 28, 2005)

> _Originally posted by asys007_@Jul 28 2005, 02:13 AM
> *
> Also, for people so against 'personal attacks', you were pretty quick to call me a 'nazi-emser'....thanks ever so much. *


What the heck is that supposed to mean?

I don't see any personal attacks against you? Obviously there is something about you that is out of public view.


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## Jon (Jul 28, 2005)

> _Originally posted by asys007_@Jul 28 2005, 03:13 AM
> * As far as documentation goes, I agree that a refusal is only as good as the documentation that supports it. ALL of my charts, including refusals, include documentation of what did/did not happen. Everything is written there, down to the patient's belongings.
> 
> And yes, I do get signatures from all patients who are able to sign. And yes, this does include refusals...who do by the way sign billing cards because they are billed for our services.
> *


 you can bill for refusals? how??? I need to get in on this racket... tap the un-accessed funds my squad has been missing 

There is NOTHING wrong with good charting... it can save you SOOO many headaches later.....

Jon


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## TTLWHKR (Jul 28, 2005)

> _Originally posted by MedicStudentJon+Jul 28 2005, 05:30 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (MedicStudentJon @ Jul 28 2005, 05:30 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-asys007_@Jul 28 2005, 03:13 AM
> * As far as documentation goes, I agree that a refusal is only as good as the documentation that supports it. ALL of my charts, including refusals, include documentation of what did/did not happen. Everything is written there, down to the patient's belongings.
> 
> And yes, I do get signatures from all patients who are able to sign. And yes, this does include refusals...who do by the way sign billing cards because they are billed for our services.
> *


you can bill for refusals? how??? I need to get in on this racket... tap the un-accessed funds my squad has been missing 

There is NOTHING wrong with good charting... it can save you SOOO many headaches later.....

Jon [/b][/quote]
Thats how the Ambulances in South East PA got in legal troubles, billing insurance companies full transport rate for refusals. That's how the protocol got changed.

The federal law is, if the patient did not initiate 911 for themselves, and they refuse - you cannot bill them. You can, however, bill the person who called 911 - IF THEY ARE A PATIENT SIGNING A REFUSAL upto $100.00. With current fuel prices, I'd have no problem with that. But I do not believe that someone who did not request an ambulance, and who does not want our help should be held accountable for a bill. In that case, we should also bill all the rubberneckers who call 911 just so they can feel better about themselves. Including the ones who call at 3am for a deer along the road, and someone burning trash.


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## Jon (Jul 30, 2005)

> _Originally posted by TTLWHKR+Jul 28 2005, 01:31 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (TTLWHKR @ Jul 28 2005, 01:31 PM)</td></tr><tr><td id='QUOTE'>
> 
> 
> 
> ...


Thats how the Ambulances in South East PA got in legal troubles, billing insurance companies full transport rate for refusals. That's how the protocol got changed.

The federal law is, if the patient did not initiate 911 for themselves, and they refuse - you cannot bill them. You can, however, bill the person who called 911 - IF THEY ARE A PATIENT SIGNING A REFUSAL upto $100.00. With current fuel prices, I'd have no problem with that. But I do not believe that someone who did not request an ambulance, and who does not want our help should be held accountable for a bill. In that case, we should also bill all the rubberneckers who call 911 just so they can feel better about themselves. Including the ones who call at 3am for a deer along the road, and someone burning trash. [/b][/quote]
 Really?

I'd always been told that you flat-out "COULD NOT BILL FOR A REFUSAL" - it was on the 3rd tablet of commandments Moses brought down from the mount.....


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## TTLWHKR (Jul 30, 2005)

> _Originally posted by MedicStudentJon+Jul 30 2005, 02:07 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (MedicStudentJon @ Jul 30 2005, 02:07 AM)</td></tr><tr><td id='QUOTE'>
> 
> 
> 
> ...


Really?

I'd always been told that you flat-out "COULD NOT BILL FOR A REFUSAL" - it was on the 3rd tablet of commandments Moses brought down from the mount..... [/b][/quote]
 Most of the time the patients in an MVA, etc, did not call 911 when they are refusing. If they don't want help, they won't be calling you. The caller is most likely a passerby with all the cell phone technology. Of course I'm sure some people do call, hoping to get just PD. Touchy subject. We never billed, 100 bucks isn'tn worth a rumor of medicare fraud.


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## asys007 (Aug 1, 2005)

Just a clarification:

We DO NOT bill insurance companies under the pretense that the patient was treated and transported...

A patient is billed for a 'refusal', pretty much we just say "hey, we responded, you owe us this pathetically low fee..." (NOT to be confused with the hefty fee we charge for an actual transport)
As far as extra money, we operate entirely on subscription drive money. There is no tax money or government input for us. In fact, 2004 was the first year where we actually made money on operations alone. We work our @$$es off on hospice transports and CORE trips, just to keep the doors open and our trucks running...


***Many of the refusals we take are for people who are subscribers, meaning they pay us a yearly fee ('donation' - $45/family) and the service picks up the tab for anything your insurance doesnt cover


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## Flight-LP (Aug 1, 2005)

> _Originally posted by asys007_@Aug 1 2005, 12:02 AM
> * Just a clarification:
> 
> We DO NOT bill insurance companies under the pretense that the patient was treated and transported...
> ...


 But again, you cannot bill an individual that did not initiate the 911 system and then refuses care. Another area that you cannot bill is the "no patient / no injuries" catagory. If you show up and no one is injured, you can't send a "hey, we responded, you owe us this pathetically low fee..." bill. 

Memberships are nice ideas in theory, except when private air services use them, but the fee is just that; a fee. It is not a donation!!!!!


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## Jon (Aug 1, 2005)

> _Originally posted by Flight-LP+Aug 1 2005, 08:59 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (Flight-LP @ Aug 1 2005, 08:59 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-asys007_@Aug 1 2005, 12:02 AM
> * Just a clarification:
> 
> We DO NOT bill insurance companies under the pretense that the patient was treated and transported...
> ...


But again, you cannot bill an individual that did not initiate the 911 system and then refuses care. Another area that you cannot bill is the "no patient / no injuries" catagory. If you show up and no one is injured, you can't send a "hey, we responded, you owe us this pathetically low fee..." bill. 

Memberships are nice ideas in theory, except when private air services use them, but the fee is just that; a fee. It is not a donation!!!!! [/b][/quote]
 Well, you can bill, but they can fight it, and not pay.... and you can be in very deep doo-doo...

Around here, most Co's are part paid, part volunteer... They always make some money. At my FD, the Ambulance makes enough to buy a brand new E450 Horton every 3 years, and have some extra money left over for the Fire. Co. to "have"

The ambulance Co. isn't rich, but they seem get by... we needed to do a significant fund drive to build our pretty new building....


Anyone else do memberships? At the FD, the company "pays" the ambulance bill of any volunteer member if insurance fails to.

At the squad, we have had an off again / on again community membership program. you ask for "X" amount of money per household, and the company waives any bills left over after insurance. The program has had several incarnations over the last 50 years, and we recently started it again after it was proven somewhere lese that it was legal.

I've heard of Acadian and others doing "membership" programs in the Louisiana Bayou or other remote uninhabited places... you call, and they send a helocopter out for you.... but you pay XX a year.... Probably not a bad deal.

Jon


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## Flight-LP (Aug 1, 2005)

Actually Jon, its a very bad idea. Acadian is a remote exception due to their geographic location and their areas inaccessable by a ground unit. As I stated in a previous thread, air memberships introduce the generally uneducated public to the option of calling a helicopter instead of 911. Outside of the obvious financial burden of flying to a BLS call, it also promotes a negative reputable image of air services as a whole and creates a multi faceted safety risk for all involved. A helicopter should not be used for a non-emergent transport, plain and simple. Just my .$02 worth...............


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## Jon (Aug 1, 2005)

> _Originally posted by Flight-LP_@Aug 1 2005, 01:21 PM
> * Actually Jon, its a very bad idea. Acadian is a remote exception due to their geographic location and their areas inaccessable by a ground unit. As I stated in a previous thread, air memberships introduce the generally uneducated public to the option of calling a helicopter instead of 911. Outside of the obvious financial burden of flying to a BLS call, it also promotes a negative reputable image of air services as a whole and creates a multi faceted safety risk for all involved. A helicopter should not be used for a non-emergent transport, plain and simple. Just my .$02 worth............... *


 Great points. I was meaning to say that some of Acadian's area or other REALLY REALLY REALLY rural areas (I'm sure you have some in Texas) are better served by aeromedical response then ground ambulance. I know in Arizona and other places, it isn't odd for Aeromedical to be the first arriving unit.

Jon


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