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

NomadicMedic

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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

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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

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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

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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

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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

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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?
 

Ewok Jerky

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It's the patients sole responsibility to be aware of their EOBs and to think about cost of healthcare before needing services. If they aren't aware of the general costs of a trip to ED then shame on them. And honestly if people were aware of the costs your call volume would drop by 2/3rds
 

johnrsemt

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If you want to share with patients more power to you: but make sure you get a detailed list, and it is updated every time it is updated by the county/state.
Also, make sure you get a detailed list of what every insurance company is going to pay for their part, and how much extra they will charge if there isn't a medical reason to transport to the hospital by ambulance.

You get into a really weird thing when it comes to billing:
Where I used to work in Indiana, it was 4 rates: ALS, Emergent and non emergent. BLS Emergent and non emergent; then mileage. But here in Utah and Nevada they can charge for almost every medical item used, and O2, and Medications; mileage is $35 a mile (fun when closest hospital is 110 miles), but if at least 1 mile of the transport is a dirt/gravel road then the entire transport is billed at $45 a mile (don't know how they do that one). And insurance pays for it
So any time people say that it is the same nation wide, they are wrong. They should be
 

spimx

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My experience is that they bill EVERYONE!!!!!!!
I don't see a problem with offering that fact if the patient is concerned. I feel that is our responsibility and also patient centered healthcare to offer the patient options and inform the patient on the healthcare provided before they consent.

The way I look at it is

implied consent: not breathing, throw them on the stretcher and go.
expressed consent: maam, lets go, please have a seat here on the stretcher so we can get going.( "I'm an old school paramedic")
informed consent: If you consent to go to the ER in an ambulance I can give you some fluids and anti-nausea medication, you should feel better and there will be a bill. (Patient centered approach)
 

spimx

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It's the patients sole responsibility to be aware of their EOBs and to think about cost of healthcare before needing services. If they aren't aware of the general costs of a trip to ED then shame on them. And honestly if people were aware of the costs your call volume would drop by 2/3rds
I dont think so. As far as responsibility, why can you not inform your patient?
 

ffemt8978

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I dont think so. As far as responsibility, why can you not inform your patient?
You mean aside from the fact that any figures you quote a patient will be inaccurate, and could lead to the proverbial "the medic told me it was only going to cost this much" dispute?
 

spimx

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You mean aside from the fact that any figures you quote a patient will be inaccurate, and could lead to the proverbial "the medic told me it was only going to cost this much" dispute?
I never heard anyone say "the medic told me it was going to cost that much"

If you do know the exact rate no harm in telling them that rate. I would just offer that there is a bill.
 

ffemt8978

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I never heard anyone say "the medic told me it was going to cost that much"

If you do know the exact rate no harm in telling them that rate. I would just offer that there is a bill.
Perhaps the reason you never heard it is because medics don't say what the bill will be.

And saying there is a bill is vastly different from telling patients what the costs could or would be.
 

Tigger

Dodges Pucks
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If you want to share with patients more power to you: but make sure you get a detailed list, and it is updated every time it is updated by the county/state.
Also, make sure you get a detailed list of what every insurance company is going to pay for their part, and how much extra they will charge if there isn't a medical reason to transport to the hospital by ambulance.

You get into a really weird thing when it comes to billing:
Where I used to work in Indiana, it was 4 rates: ALS, Emergent and non emergent. BLS Emergent and non emergent; then mileage. But here in Utah and Nevada they can charge for almost every medical item used, and O2, and Medications; mileage is $35 a mile (fun when closest hospital is 110 miles), but if at least 1 mile of the transport is a dirt/gravel road then the entire transport is billed at $45 a mile (don't know how they do that one). And insurance pays for it
So any time people say that it is the same nation wide, they are wrong. They should be
Any service can choose to use itemized billing. There are no state/county lists.

No one is suggesting you’ll know what a patient’s insurance is going to cover. It is however completely within a provider’s purview to know, roughly, the cost of the service that they’re providing.

I don’t understand what is so difficult to grasp here.
 

NomadicMedic

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Any service can choose to use itemized billing. There are no state/county lists.

No one is suggesting you’ll know what a patient’s insurance is going to cover. It is however completely within a provider’s purview to know, roughly, the cost of the service that they’re providing.

I don’t understand what is so difficult to grasp here.
 

chriscemt

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By not sharing the information are we contributors to the huge medical debt crisis?

I would dare say that the responsibility of the medical debt crisis is about 97% very poor decisions on the part of individuals, about 2.999% the result of some bad luck or other factors out of the control of the individual and about 0.001% the result of ignorance of ambulance transport billing policies.
 

mgr22

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I would dare say that the responsibility of the medical debt crisis is about 97% very poor decisions on the part of individuals, about 2.999% the result of some bad luck or other factors out of the control of the individual and about 0.001% the result of ignorance of ambulance transport billing policies.
What percentage of those individuals do you think have enough guidance to make good decisions?
 

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