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

NomadicMedic

Pot or Kettle? Unsure.
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It’s important to realize the cost for service, the price for service and the actual reimbursement for service are all very different.
 

E tank

Caution: Paralyzing Agent
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It’s important to realize the cost for service, the price for service and the actual reimbursement for service are all very different.
And depending on the area, there may be assessments attached to property taxes that go to offset EMS expenses. So @FiremanMike offers that they get 230 back per ALS call. That probably covers their cost for supplies and maybe some fuel. We're talking public agencies here...Suppression side of fire and LE don't get to send bills to folks, so in terms of the public safety sector it may be a wash. We don't think of fire and police agencies as 'breaking even' or 'losing money' but we do of EMS. That's a false equivalency and does not reflect the reality.
 

FireMedicPrepper

Forum Ride Along
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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?
You must always be an advocate for the patient and do what is in the best interest of the patient. Yes, sometimes you may need to discuss the fees. However, you have a patient with an obvious STEMI that doesn't want to be transported, It might be in the best interest for the patient to be transported. On the other hand, You have a patient that is not critical and VERY stable in which case it might be in there best interest to let them refuse and have a family member transport them. It is all on a case by case basis.
 

ffemt8978

Forum Vice-Principal
Community Leader
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You must always be an advocate for the patient and do what is in the best interest of the patient. Yes, sometimes you may need to discuss the fees. However, you have a patient with an obvious STEMI that doesn't want to be transported, It might be in the best interest for the patient to be transported. On the other hand, You have a patient that is not critical and VERY stable in which case it might be in there best interest to let them refuse and have a family member transport them. It is all on a case by case basis.
"Sometimes you may need to discuss the fees"?

Do you study up on every change and update to the fee structure of your agency, every insurance company and Medicare/Medicaid? If not, then you are providing your patient with inaccurate information that may have a deteimental effect on them giving consent for treatment.

From a patient advocate aspect, the best method is to provide them with your billing clerk's contact information, and let them answer those questions because they are in a much better position to do so accurately.

If you have a stable patient that doesn't warrant EMS treatment and transport, there are other ways to convince them to refuse...unless you're talking about a scenario of "you don't need an ambulance ride to go to the doctor, so you can save yourelf the fee by going in yourself." Even then, are you truly advocating for what is medically best for the patient?
 

johnrsemt

Forum Deputy Chief
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FT job is cheapest in the state; if not free.
PT job is average of $6,000 transport up to $10,000 depending on where we start. and we charge for treat and release (every time I say that I think catch and release in fishing, and I have said it a couple of times). and charge for refusals
 

Tigger

Dodges Pucks
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"Sometimes you may need to discuss the fees"?

Do you study up on every change and update to the fee structure of your agency, every insurance company and Medicare/Medicaid? If not, then you are providing your patient with inaccurate information that may have a deteimental effect on them giving consent for treatment.

From a patient advocate aspect, the best method is to provide them with your billing clerk's contact information, and let them answer those questions because they are in a much better position to do so accurately.

If you have a stable patient that doesn't warrant EMS treatment and transport, there are other ways to convince them to refuse...unless you're talking about a scenario of "you don't need an ambulance ride to go to the doctor, so you can save yourelf the fee by going in yourself." Even then, are you truly advocating for what is medically best for the patient?
I don’t think providing a phone number and nothing else is exactly honest either. I know what my agency bills for its three run types, it’s not a secret. It is ok to tell the patients that information along with “I have no idea what your insurance plan may cover.” Intentionally obfuscating your billing practices is not good policy.

I am not using this as leverage, I’m just answering patients to my best ability when they ask so they can make the best decision for them. Cost is a component of healthcare, to argue otherwise is silly.

As to the last part, of EMS transport is of no benefit to the patient, then telling them they should be transported would in fact not be in their best interest and a good example of advocating for your patient. If someone wants to be transported, I won’t try to change their mind. If they ask if I think it’s necessary and it’s not, should we just lie and then send them a bill?

We do healthcare, it’s time to act like it. If your doctor says “hey you should get an MRI,” and your insurance won’t cover it, you’re going to have to have a make decision that involves your health and finances. Most of EMS calls aren’t time sensitive, why are we not allowing patients to make the same informed decision? If you don’t know what your agency bills, maybe find out?
 

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