# Transport billed... To a dead man's family.



## SandpitMedic (May 2, 2015)

http://www.ems1.com/ems-products/am...9-dead-texas-inmate-billed-for-ambulance-ride


So basically this Darwinist ate a bunch of meth and later died after going to jail, being found unresponsive, and being transported to the ER.

His father received a bill from the ER AND the ambulance company.

So apparently people are upset?! How about... Don't eat your meth...actions have consequences. Why should the tax payers pay for that scum bag? 


Anyways, just wanted to get a take on how ya'll feel... Since you deal with this crap all the time.


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## NomadicMedic (May 2, 2015)

Non issue. We bill for unsuccessful cardiac arrest resus attempts.


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## Carlos Danger (May 2, 2015)

No problem with billing for services provided. However, my understanding is that once the government takes custody of an individual, they are then responsible for their medical care. Which is as it should be, IMO.

Maybe if we as taxpayers don't want to pay medical bills for people in police custody (not to mention the other costs of housing prisoners), we should get rid of laws that both directly and indirectly result in the arrest and very often the injury and death of non-violent "criminals"? Doubt this guy would have swallowed the meth if he didn't have to fear being caged like an animal for a long period of time over mere possession of something that should be legal among consenting adults. 

Not sure why you assume that just because someone is in possession of a drug, that they are necessarily a "scum bag".

I know that probably isn't the direction you wanted to see this thread go, but you asked....so there you go.


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## FF-EMT Diver (May 2, 2015)

Non issue as well, we bill if we provide services.

Remi are you being serious or facetious?


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## SandpitMedic (May 2, 2015)

Oh, he's very serious.

We don't agree on much, yet I can respect his well articulated position.


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## escapedcaliFF (May 2, 2015)

Bill them!!! Why should the tax payers pay for it. Already enough parasites on the government tit.


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## Carlos Danger (May 2, 2015)

FF-EMT Diver said:


> Remi are you being serious or facetious?



I'm not even sure where to start. This is a HUGE issue, one of those "if you have to ask, you wouldn't understand" kind of things.

Let's just say that as a society, we have allowed ourselves to be massively brain[censored] when it comes to drugs and the people who choose to consume them. 

And from that is where all of this flows. 

We beg the government to do violence against us to protect us from our personal choices and then make excuses for it. Not entirely unlike an abused wife who lies to protect her abusive husband.


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## SandpitMedic (May 2, 2015)

#Remi2016!

LOLZ


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## OnceAnEMT (May 2, 2015)

No opposition from me on billing dead people. Last thing I want to see is "You'll live, or your money back!"



Remi said:


> No problem with billing for services provided. However, my understanding is that once the government takes custody of an individual, they are then responsible for their medical care. Which is as it should be, IMO.



I agree, but unfortunately there is some grey area. Does this mean the government should also pay for a pedi's code because there was no parent/guardian available at the time? For psych patients that are on a psych hold?

Where is the line drawn between "This is what the patient would want" and "This is what the government wants"?


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## RedAirplane (May 3, 2015)

Again, I find it absolutely horrifying that EMS and hospitals charge the patient for service at all.

I've had too many patients who were concerned about the cost of an ambulance ride refuse care even after being advised it was in their best interest.


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## Handsome Robb (May 3, 2015)

Ishan said:


> Again, I find it absolutely horrifying that EMS and hospitals charge the patient for service at all.
> 
> I've had too many patients who were concerned about the cost of an ambulance ride refuse care even after being advised it was in their best interest.



So who pays for it then if users of the system don't?


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## escapedcaliFF (May 3, 2015)

The good news is with him committing suicide via meth he saved the tax payers untold thousands in incarceration and court costs. Now don't get me wrong the justice system is assbackwards nowadays. Child rapist and drug dealers go free after a year but some poor gun owner is doing 10 years cause a certain gun feature is illegal in Komifornia. Oh hell don't even get me started on the illegals.


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## Carlos Danger (May 3, 2015)

To me it is all very simple: I believe strongly that every individual has the God-given right to make_ all _of his or her own choices in life -  and deal with the consequences. This includes choices about what to eat or drink, whether to exercise or not, whether to go to college, whether to be into chicks or dudes, whether to drink alcohol, and yes, whether to use drugs. The logical extension of that is that no one has the right to forcefully interfere with anyone else making those choices. The Southern Baptists don't have to _like_ the fact that I go out and have drinks with breakfast on Sunday morning instead of going to church, but it is morally wrong of them to try to use force to stop me. The greenies don't have to _like _my V-10 Excursion with the "drive a hybrid - I need your gas" sticker on the back window, but they have no right to take it from me. I don't have to _like_ seeing two dudes kiss in public in front of my kids, but I have no right to try to physically stop them. This is the lens through which I view pretty much everything in life, and it's why I think drug laws are every bit as immoral and unjust as would be laws against homosexuality or violent video games or pornography or owning firearms or buying alcohol on Sunday. 

Not only is it immoral to lock someone up because they choose to use drugs, but it's just horrible public policy. Prohibition _never_ works. As a result, and quite predictably, the entire "war on drugs" has been an abject failure. It's done almost nothing to curb drug use in the US. Instead, it's cost billions of dollars, resulted in completely unnecessary police violence against countless non-violent people, and been the basis for a serious erosion of other civil rights over the past several decades. It feeds the violent black market for drugs that will never go away. The entire "war on drugs" has caused far more problems than it was ever even attempting to solve.

Drug users generally fall into one of two categories: the casual recreational user who lives a pretty normal life and isn't harming anyone else with their use, or the addict who seriously needs help, yet is probably still not harming anyone else with their use. It's a fact that very few drug users ever commit violent crimes, and it's also a fact that most people who experiment with drugs, even hard drugs, never become addicts. The stereotype of the person trying heroin once and instantly becoming hooked and turning to violence to feed their uncontrollable habit is a myth. In reality very few drug users fit that picture.  

So this is why when I hear about someone being arrested just because they had some drugs on them, I don't assume they are some scumbag criminal who deserves to get beat up by the cops and then thrown in a cage for years. Quite the opposite, I see them as a victim of violence.


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## DrParasite (May 3, 2015)

Ishan said:


> Again, I find it absolutely horrifying that EMS and hospitals charge the patient for service at all.
> 
> I've had too many patients who were concerned about the cost of an ambulance ride refuse care even after being advised it was in their best interest.


then who pays for it?  I'll forgive your ignorance, but the money needs to come from somewhere.  Everything involved in an ambulance call can be documented as a financial cost, whether it be personnel salaries, to diesel fuel, to equipment used.

Furthermore, why should the service be free?  If you want a service, you should expect to pay for it.  If you are that concerned about the bill, then don't take the ambulance, take a taxi to your doctor; but don't be surprised when the taxi driver wants to get paid, as does your doctor.

I will agree to the fact that, if the person was in the custody of law enforcement, they might have a decent argument that they are not responsible for the bill.  They didn't call for the ambulance (the cops did), and they didn't consent to be treated and transported (typically this is the LEO's call, as the person is in their custody).  After all, if I didn't call for the help, nor did I consent to be treated or accept responsibility for the bill, I wouldn't want to pay the bill either. 

The fact that he was unresponsive from a meth OD (implied consent, etc) is something to be negotiated after the fact.


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## RedAirplane (May 3, 2015)

When's the last time you got billed for a fire department first response to your house? It's a service that costs time of workers and use of expensive equipment.

I would say it's a public good. Having the service taxpayer/donor funded would allow those who need it most to use it. And don't get me started on hospital bills. 

The first responder organizations I work with are both free to patients, and funded by venue contracts and donations. 

My hometown has a model of taxpayer/donor funding. The county recently mandated a $50 fee per transport if the department wants to get government money. Some agencies turned down this money so as to continue being free, running a well staffed ALS/BLS system with faster response times than any other I've seen, using donations only. 

Meanwhile in California the baseline charge is $800 with a whopping 8 minute response time.  When I moved here and heard that, I thought it nothing less than highway robbery.


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## Carlos Danger (May 3, 2015)

Ishan said:


> When's the last time you got billed for a fire department first response to your house? It's a service that costs time of workers and use of expensive equipment.
> 
> *I would say it's a public good. Having the service taxpayer/donor funded would allow those who need it most to use it.* And don't get me started on hospital bills.



I never used to think that, but more and more now I do. Not because I really like that option, but because I think it's better than the mess we have now, which ends up being largely taxpayer subsidized anyway.

Hospitals are another thing entirely. Very complex.


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## OnceAnEMT (May 3, 2015)

Remi said:


> I never used to think that, but more and more now I do. Not because I really like that option, but because I think it's better than the mess we have now, which ends up being largely taxpayer subsidized anyway.



This is a very good point. I am curious of the statistic of how many dollars go unpaid towards EMS-related bills.

In a perfect, socialist system it really would make sense for all first responder (EMS, Fire, LEO) to come without bills, and be completely subsidized by taxes. It would take pressure off those who have less finances but more medical problems, acute or chronic. Some would argue that the pressure is not eliminated, its just transferred to those of higher tax brackets. I argue they won't be saying that when their or their family's ticket is up.

The above opinion relates to 911, where there would be a need to increase education on the rightful/wrongful use of 911, and enforcement of improper use. Non-emergent IFT (time to take Bubba to dialysis) ought to be billed as long as that dialysis treatment is being billed.


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## DrParasite (May 3, 2015)

Ishan said:


> When's the last time you got billed for a fire department first response to your house? It's a service that costs time of workers and use of expensive equipment.


yes, and they are funded by taxpayers, as the system should be.  If you want a service you pay for it.





Ishan said:


> I would say it's a public good. Having the service taxpayer/donor funded would allow those who need it most to use it. And don't get me started on hospital bills.
> (snip)
> My hometown has a model of taxpayer/donor funding. The county recently mandated a $50 fee per transport if the department wants to get government money. Some agencies turned down this money so as to continue being free, running a well staffed ALS/BLS system with faster response times than any other I've seen, using donations only.


donations???? are you nuts?  you are relying on the goodness of people to fund an essential service???  do you believe in the tooth fairy too?

I'd gladly accept giving everyone a free ride regardless of services, if the system was 100% taxpayer funded.  After all, the tax payers are paying for the service (and I would even cover their friends, guests and travelers just make things easier).  But you don't see any other essential service that has to beg for money for operational equipment (fuel, NRBs, etc), so while I wouldn't turn down a donation, running an EMS agency solely on donations is a sign you are stuck in the past, and you will get burned once the donations dry up.


Ishan said:


> Meanwhile in California the baseline charge is $800 with a whopping 8 minute response time.  When I moved here and heard that, I thought it nothing less than highway robbery.


Are you referring to private service, or a taxpayer funded government operated ambulance?  If the former, then they get no other income except from transports, so you are paying for the EMS system.  if it's a government tax funded ambulance, well, then you might have an argument.... but you did chose to move there, so.....


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## RedAirplane (May 3, 2015)

I was essentially trying to say-- use funding sources besides the patient. The breakdown of tax/donor is less important to me.

(Also, think of the "do no harm" aspect. Is it ethical for a medical provider to send a patient a bill which would certainly give him/her a heart attack? )

I'm also still trying to figure out what makes a BLS ambulance ride start at $600. Fuel is expensive, but not that much. EMTs are not getting exorbitant salaries. Except for the AED, nothing in a BLS kit is particularly costly (and anyway, it's billed on top of the base rate). The ambulance itself, perhaps? QA/QI processes?


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## Handsome Robb (May 3, 2015)

The fact that we get ~35 cents on the dollar from Medicare when we bill them has a lot to do with rates being so high. The fact that many do not ever pay their bill doesn't help either.

Besides materials, gas and salaries there's other costs included. Wear and tear on the vehicle, the benefits of every employee are factored into their "hourly cost" for the company, the cost of the maintenance on the vehicle, the cost of the dispatcher, the cost of the person paid to stock the ambulance, the cost of the person paid to do the billing, so on and so forth. 

I make ~20/hr however after my benefits and continuing education they pay for I cost the company around 40-45/hr when I'm not on OT. On OT that cost goes above 50/hr. My EMT partner is in the 30/hr range. 

A lot more goes into running an emergency response system besides just the cost of fuel, the providers' hourly wages and the supplies they use.


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## Tigger (May 4, 2015)

Ishan said:


> I'm also still trying to figure out what makes a BLS ambulance ride start at $600. Fuel is expensive, but not that much. EMTs are not getting exorbitant salaries. Except for the AED, nothing in a BLS kit is particularly costly (and anyway, it's billed on top of the base rate). The ambulance itself, perhaps? QA/QI processes?



There are hundreds of costs associated with providing ambulance service, most of them having nothing to do with the ambulance itself. 

Rates are not just made up. We know how many calls we expect to run. We know how much money we can expect to collect per call. We know what are our operating expenses are. From this it is fairly easy to determine how much we need to charge per call.


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## RedAirplane (May 4, 2015)

I was half sarcastic half serious.

I know the numbers don't just come out of nowhere, they just seemed unbelievably high.


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## escapedcaliFF (May 4, 2015)

Ishan said:


> I was half sarcastic half serious.
> 
> I know the numbers don't just come out of nowhere, they just seemed unbelievably high.



A $1,000 dollar ambulance ride is a small amount. Each place has maximum they are allowed to charged for services rendered. For example some places might charge $300 bucks just cause the call was at night. Some even charge extra if it's a ALS ambulance even though a BLS was more than enough just cause the ALS wasn't busy. The rates are set by the county/state and trust me ambulance company's will always charge the max under the rates.


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## RedAirplane (May 4, 2015)

escapedcaliFF said:


> A $1,000 dollar ambulance ride is a small amount. Each place has maximum they are allowed to charged for services rendered. For example some places might charge $300 bucks just cause the call was at night. Some even charge extra if it's a ALS ambulance even though a BLS was more than enough just cause the ALS wasn't busy. The rates are set by the county/state and trust me ambulance company's will always charge the max under the rates.



...and air ambulances for rural trauma make this seem like petty change...


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## escapedcaliFF (May 4, 2015)

Ishan said:


> ...and air ambulances for rural trauma make this seem like petty change...



I know of someone charged $573,000 for air medivac for so yeah.


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## RedAirplane (May 4, 2015)

escapedcaliFF said:


> I know of someone charged $573,000 for air medivac for so yeah.



Yikes! The ballpark number I heard was $17,000. When we're into six digits, I'm not sure if I'd want to wake up after that ride. (Kidding)


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## escapedcaliFF (May 4, 2015)

Look at Alaska. They run planes up there. For a air medvac from Purdue Bay to a speciliaty trama clinic in Anchorage I would hope I die on the way.


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## Tigger (May 4, 2015)

escapedcaliFF said:


> A $1,000 dollar ambulance ride is a small amount. Each place has maximum they are allowed to charged for services rendered. For example some places might charge $300 bucks just cause the call was at night. Some even charge extra if it's a ALS ambulance even though a BLS was more than enough just cause the ALS wasn't busy. The rates are set by the county/state and trust me ambulance company's will always charge the max under the rates.


Billing an ALS rate for a BLS call (even if the paramedic was in back) is fraud in most cases, CMS is pretty clear about that.


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## escapedcaliFF (May 4, 2015)

Tigger said:


> Billing an ALS rate for a BLS call (even if the paramedic was in back) is fraud in most cases, CMS is pretty clear about that.



Look up Liberty ambulance. They have gotten away with it a couple times in their AOR in Kern county Kalifornia. I can think of a couple of cases. FD and Liberty have gotten into over this cause FD thinks it's BLS but once BLS shows they think ALS is needed even though the FD engine paramedic says its BLS. Literally been a pissing match over this and last I checked they cleaned it up and came to an understanding. That's all it was a pissing match not really fraudulent but close.


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## Ensihoitaja (May 4, 2015)

Tigger said:


> Billing an ALS rate for a BLS call (even if the paramedic was in back) is fraud in most cases, CMS is pretty clear about that.



I thought they could bill for the "ALS Assessment" even if it turned out to be a BLS call otherwise. Did that change?


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## PotatoMedic (May 4, 2015)

If Als is dispatched initially then yes you can bill als. But if bls calls for an Als assessment then you can only bill the bls rate if bls transports.


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## escapedcaliFF (May 4, 2015)

The issue with Liberty is they where sending BLS to calls dispatched as BLS and then they would ask for the ALS. They would show and transport cause Liberty medics decided it was ALS even though it could of gone BLS. It wasn't just some isolated cases of a EMT not being comfortable transporting BLS either. It was a pattern and didn't stop until FD raised concerns.


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## Ensihoitaja (May 4, 2015)

FireWA1 said:


> If Als is dispatched initially then yes you can bill als. But if bls calls for an Als assessment then you can only bill the bls rate if bls transports.



That makes sense, thanks!


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## JeffT (May 5, 2015)

Bill it, but don't expect to get paid.  On a side note, something a hospital I used to work for did a lot was bill "patient convenience fee" for any ambulance run where no actual transport was done (usually diabetic, etc.).  Discussing it in class no one else had heard of that type of maneuver. Is that type of billing something that is done industry wide or is it just something the penny pinchers at my ol hospital did.  Usually insurances did not cover the 'patient convenience fee' so it aggravated the heck out of the folks getting the bills... especially if the patient was not who called 911 and it was someone else that saw them have a low.


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## escapedcaliFF (May 5, 2015)

JeffT said:


> Bill it, but don't expect to get paid.  On a side note, something a hospital I used to work for did a lot was bill "patient convenience fee" for any ambulance run where no actual transport was done (usually diabetic, etc.).  Discussing it in class no one else had heard of that type of maneuver. Is that type of billing something that is done industry wide or is it just something the penny pinchers at my ol hospital did.  Usually insurances did not cover the 'patient convenience fee' so it aggravated the heck out of the folks getting the bills... especially if the patient was not who called 911 and it was someone else that saw them have a low.



Yep seen it done plenty of times. Look up Mesa AZ Fire. They run these things called "community care units". Basically a BLS that fire runs for non 911 calls. Southwest (rural metro) runs 911 BLS and ALS for Mesa but Fire Dept started doing the community care units in partnership with a local hospital. Its kinda a shady deal cause its a money making scem dreamed up by the city FD and backed by the local hospital.


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## Tigger (May 5, 2015)

Ensihoitaja said:


> I thought they could bill for the "ALS Assessment" even if it turned out to be a BLS call otherwise. Did that change?


That's still possible but I don't think that changes the base rate of the call from BLS to ALS Level 1.



JeffT said:


> Bill it, but don't expect to get paid.  On a side note, something a hospital I used to work for did a lot was bill "patient convenience fee" for any ambulance run where no actual transport was done (usually diabetic, etc.).  Discussing it in class no one else had heard of that type of maneuver. Is that type of billing something that is done industry wide or is it just something the penny pinchers at my ol hospital did.  Usually insurances did not cover the 'patient convenience fee' so it aggravated the heck out of the folks getting the bills... especially if the patient was not who called 911 and it was someone else that saw them have a low.



We bill treat and releases where medications are administered (usually D50 and NS). Many insurances reject it, including Medicare and Medicaid. Those two will only pay if the patient is transported.


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