Do we have a responsibility to share potential fees with patients?

Tigger

Dodges Pucks
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Yes. If the crew is wrong, here come the lawsuits, in case you haven’t noticed, Ameridians will sue at the drop of a hat.
There is no need to dump all this on a crew. Non emergent calls to a company can be dealt with by a QC person handed off from dispatch.

Again. What does this have to do with field care? What if it’s a FD handoff and since taxes pay for FD services, then you tell them it’s $$$, and the rightfully demand the “free ride” from FD, who refuses, what then? The crew has to step in the middle of it? Please. Stop trying to foist ever single issue onto the workers.

Fees have ZERO to do with informed consent. Wil we then allow the patient to dictate what care they get to save money? If so, you just made a perfect argument for BLS only EMS. Go cheap. No harm in that, eh?
I don’t understand how it’s so difficult for the crews to be aware of the costs are. It’s public record for public entities and many 911 contracts. Print the rate sheet and put it in the clipboard. These are not launch codes.
 

DrParasite

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I don’t understand how it’s so difficult for the crews to be aware of the costs are. It’s public record for public entities and many 911 contracts. Print the rate sheet and put it in the clipboard. These are not launch codes.
ok, I'll ask the question out of ignorance... how are ambulance runs billed? is it one flat fee for ALS1, ALS2, and BLS (plus millage), or does the bill vary by equipment used? If I do a BLS taxi ride to the hospital (patient walks to the truck, sits on the bench, is taken into the ER by wheelchair with no interventions other than an assessment performed), is that $350? but if I have a patient who falls off the roof, with bilateral tib fib fx and an arterial lac that is spurting (requiring splinting, TQ, spine board, C collar, oxygen just because, bandages, and blankets to keep warm), is that also $350? or is it $350 plus the cost of any equipment used to treat the patient (because I am on a BLS transport unit, and the nearest ALS flycar was 30 min away)? If I am on an ALS truck, is the bill different if give the CHFer full of fluid unable to breathe a ton of nitro and cpap, compared to an asthmatic who gets a neb treatment and a nice easy ride to the hospital?

I honestly don't know, but I am thinking that ignorance that makes many of us (myself included) uncomfortable discussing fees with our patients.
 

ffemt8978

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ok, I'll ask the question out of ignorance... how are ambulance runs billed? is it one flat fee for ALS1, ALS2, and BLS (plus millage), or does the bill vary by equipment used? If I do a BLS taxi ride to the hospital (patient walks to the truck, sits on the bench, is taken into the ER by wheelchair with no interventions other than an assessment performed), is that $350? but if I have a patient who falls off the roof, with bilateral tib fib fx and an arterial lac that is spurting (requiring splinting, TQ, spine board, C collar, oxygen just because, bandages, and blankets to keep warm), is that also $350? or is it $350 plus the cost of any equipment used to treat the patient (because I am on a BLS transport unit, and the nearest ALS flycar was 30 min away)? If I am on an ALS truck, is the bill different if give the CHFer full of fluid unable to breathe a ton of nitro and cpap, compared to an asthmatic who gets a neb treatment and a nice easy ride to the hospital?

I honestly don't know, but I am thinking that ignorance that makes many of us (myself included) uncomfortable discussing fees with our patients.
Ever wonder why you have to document all procedures you performed and equipment used on those procedures? One of the reasons is billing for reimbursement...either from insurance or the patient.
 

DrParasite

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Ever wonder why you have to document all procedures you performed and equipment used on those procedures? One of the reasons is billing for reimbursement...either from insurance or the patient.
I figured it had something to do with billing or supply accountability... but how much as a NRB cost the patient? how much does oxygen? how much does a C-collar? how much is tape? how much are board splints? how much are blankets? how much are triangle bandages? is a splint composed of 2 board splints and two triangular bandages, is that cheaper for the patient than a commercially made splint? if that's the case, can and should the patient be consulted to decide which splint they want applied? If I give someone a bandaid, at a special event, should they get a balance sheet that says the bandaid will cost them $22? even though the box of 100 costs $10?And that doesn't even cover the cost of any drugs or medications.

Are we going to give every patient a billing list of every item on the ambulance, and ask them what they want or don't want? And remember, we can only give them the cost we are charging, insurance rates are different, depending on what company and if they have negotiated rates. Are self-pay rates cheaper than what we charge for insurance?

About 20 years ago, I asked a paramedic in upstate NY how much her agency charged for services. my memory is a little foggy, but I think It was a flat rate, $350 for BLS, and $650 for ALS. didn't matter if it was just a neb treatment, or they used every drug in the drug box, it was a flat rate. Times might have changed, but that's a lot easier to explain than providing a spreadsheet of what everything costs.

EMS billing (and medical billing in general) is not something I am educated in, and there are courses that spend weeks teaching it.

If a trip is a simple flat rate, I can explain that pretty easily. once you start itemizing, it gets more complicated. Not only that, but does anyone want Mr "I am having a STEMI" to choose to drive himself to the hospital to save $1000 on the ambulance ride, even though the hospital is going to charge him $50,000 for the cath?
 

E tank

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Fees mean nothing in medical care. A $1000 ambulance bill is one thing to a 70 yo with Medicare, another to a 45 year old with one of the Blues and another to the 24 year old with Medicaid or nothing. If someone is dialed in enough to be concerned about the ambulance bill, they should know that the ER/hospital bill will make that look like a bargain. Having someone look at a "price list" and picking stuff off of it like it's a menu at Chili's (cause that's what would happen) would seem to be the last thing someone would want. Good intentioned and all, I get it, but misapplied.
 

johnrsemt

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It is annoying that it varies from place to place:
When I worked in Indiana (almost 13 years ago so it may have changed) we have 4 rates: AlS, BLS, Then Emergent and Non Emergent: Plus $10.95 a mile. Nothing else.
Here in Utah there is a flat rate for ALS and BLS, Emergent and non emergent; then you can charge for supplies, and equipment used (electrodes AND lifepak for example). Also mileage is $35 a mile: but if at least 1/2 mile is dirt or gravel the entire trip is billed at $45 a mile: Or at least that is what I have been told.......Where I work FT it is Federal and we charge a flat fee for everything.
PT job is similar but all ground transports run approx $6,000, but we are approx 120-140 miles to closest hospital (and that is if the run starts in the town we are based in, we can go almost 100 miles out of town, then back to town, then to the hospital, so those can run almost $8,000-9,000).

Charges need to be the same nationwide, with a mileage fee tacked on.
 

ffemt8978

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Charges need to be the same nationwide, with a mileage fee tacked on.
Except that the costs of operating an EMS service vary by region. There's a reason a $15/hr job in BFE is an okay wage while that same wage wouldn't be enough to make ends meat in cities.

There is no one size fits all solution to the problems we face in EMS, and we need to stop believing there is and instead focus on real, sustainable changes that can be made.
 

GMCmedic

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Charges need to be the same nationwide, with a mileage fee tacked on.

This would aslo require the federal government to be involved in something the federal government has no business being involved in.

EMS billing is a State, or rather more appropriately, a municipalities issue.
 

DrParasite

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EMS billing is a State, or rather more appropriately, a municipalities issue.
Why? If I call 911 for an ambulance, and town A's service charges $100, but they are tied up and town B is sent (who charges $200), is that fair to the patient? Should town A not use town B for mutual aid, because they charge more, despite the fact that they are closer? If I live in Town B, can I call 911 and request Town A's service be sent, because they will be providing the same service for half the price? What if I'm involved in a 3 car crash, with multiple ambulances sent. Can I pick which ambulance I want to treat me, based on how much they will charge me for the same services?

If I have insurance, but they will only pay $100 (because that is the standard rate), when Town B comes in mutual aid, insurance won't get paid more, does that patient gets stuck with the balance? Or does Town B need to take a loss? What if the reason town A charges less is because they are taxpayer-subsidized, while town B is a private/for-profit that relies solely on billing to cover expenses? Should residents pay less than non-residents? should insurance payout rates differ based on residency?

There is no simple answer, and a lot of variables to consider. I don't think it's as easy as saying each municipality decides how it will bill. and I definitely don't feel like I understand the charges well enough to discuss it with the patient.
 

FiremanMike

EMS Coordinator
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I figured it had something to do with billing or supply accountability... but how much as a NRB cost the patient? how much does oxygen? how much does a C-collar? how much is tape? how much are board splints? how much are blankets? how much are triangle bandages? is a splint composed of 2 board splints and two triangular bandages, is that cheaper for the patient than a commercially made splint? if that's the case, can and should the patient be consulted to decide which splint they want applied? If I give someone a bandaid, at a special event, should they get a balance sheet that says the bandaid will cost them $22? even though the box of 100 costs $10?And that doesn't even cover the cost of any drugs or medications.

Are we going to give every patient a billing list of every item on the ambulance, and ask them what they want or don't want? And remember, we can only give them the cost we are charging, insurance rates are different, depending on what company and if they have negotiated rates. Are self-pay rates cheaper than what we charge for insurance?

About 20 years ago, I asked a paramedic in upstate NY how much her agency charged for services. my memory is a little foggy, but I think It was a flat rate, $350 for BLS, and $650 for ALS. didn't matter if it was just a neb treatment, or they used every drug in the drug box, it was a flat rate. Times might have changed, but that's a lot easier to explain than providing a spreadsheet of what everything costs.

EMS billing (and medical billing in general) is not something I am educated in, and there are courses that spend weeks teaching it.

If a trip is a simple flat rate, I can explain that pretty easily. once you start itemizing, it gets more complicated. Not only that, but does anyone want Mr "I am having a STEMI" to choose to drive himself to the hospital to save $1000 on the ambulance ride, even though the hospital is going to charge him $50,000 for the cath?
We don't itemize, but the documented procedures/medications are how our billing company determines what level to bill at..
 

ffemt8978

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We don't itemize, but the documented procedures/medications are how our billing company determines what level to bill at..
When I was with a government agency, that was the same thing we did. When I worked for a private company, they itemized in order to get reimbursed.
 

johnrsemt

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All good points of why a nationwide fee/billing won't work.
But while I worked in Indiana it was the same statewide: Fire based that was tax supported, hospital based that was part tax supported part hospital, or private EMS. We all billed the same. I worked 911 Fire based, and Private EMS and we billed the same, although the Private EMS probably made more money because we worked with more people who had insurance and paid their bills.
 

GMCmedic

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All good points of why a nationwide fee/billing won't work.
But while I worked in Indiana it was the same statewide: Fire based that was tax supported, hospital based that was part tax supported part hospital, or private EMS. We all billed the same. I worked 911 Fire based, and Private EMS and we billed the same, although the Private EMS probably made more money because we worked with more people who had insurance and paid their bills.
As in all 3 services billed the same price? Or billed the same way (BLS, ALS1, ALS2, CCT, etc)
 

ZombieEMT

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One thing that I have wished to see change is for many years, is the way that providers act in regards to billing practices. I do not necessarily important to known exact numbers, but I do think we should have basic knowledge of our agencies billing practices. When patients ask about billing, I hate the answers "I don't know," "That's not my job," "The billing company will worry about that," and "we can worry about that later." Patients worry about billing. None of those answers give them relief. Some want to know what they are paying for or aren't.

Many providers feel like it is not their responsibility and shouldn't have to. Many say they will refuse to talk about billing or collect insurance info. Yet, many of the same people will get a hole lot of information/demographics that are not really relevant to care. What do they think that is used for?
 

HunterTMars

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At least once a year I hear from people about how absolutely shocked they are at the cost of an EMS transport.

Why aren't we advising patients of the costs prior to transport?

As an EMT I was always quick to say that I didn't know about billing, because I didn't know much beyond anecdotes from partners.

Surely the medical billing department has a document that outlines costs for transport, mileage, and different treatments.

By not sharing the information are we contributors to the huge medical debt crisis?
Discussing cost of transport with patient's isn't a good idea. EMS re-reimbursement is extremely complex and each situation is unique. For systems that don't recommend a response to questions about the cost of transport, maybe they should. It might help to thwart risk and liability.

Also, just a thought. Somewhere along the way EMS professionals began to spend too much time thinking about billing re-reimbursement instead of staying focused on what matters - patient care. My sense is that EMS management is culpable in this; if managers talk to much about cost and reimbursement, employees lose focus. Strong EMS leaders stay focused on the quality of patient care.
 

Antafinyb

Forum Ride Along
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Each case is very different. And doctors are not accountants, they don't have time to count money when it comes to saving a life.
 

Fezman92

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I was talking to one of our dispatchers who used to deal with billing and the average cost of a BLS transport (IFT) is around $800 and ALS $1,500-2,000.
 

E tank

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I was talking to one of our dispatchers who used to deal with billing and the average cost of a BLS transport (IFT) is around $800 and ALS $1,500-2,000.
No...the cost and the bill (and the payment) are 3 different things...
 

Fezman92

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Oh.
 

ffemt8978

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No...the cost and the bill (and the payment) are 3 different things...
5 if you include insurance and Medicare/Medicade.
 

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