In the county where I work, we only bill the pt's insurance. No out of pocket payment is requested by DAB (diversified ambulance billing). If you're not a county resident, you'll be billed. Regardless of where you live, you can fill out and submit a financial hardship waiver and not have to pay. Otherwise, your bill goes to collections after three bills are sent.
I've worked for two IFT companies, and my old hospital that also does IFT. In my experience, the txp will simply not be scheduled if the company is not compensated.
At my 911 job, we don't charge if there's no transport. If the pt says they won't go because they're uninsured and can't afford it, I fully inform them of the consequences of refusing txp, and also the county's billing policies. It was the same back in NYC. The situation is what it is. I'm not going to lie to the pt. To feign ignorance as to if they'll be billed or not is also lying. I always tell them the straight story. It may come over as harsh, but lying to them isn't doing them any good. The pt (or their guardian) is an adult, and they're going to have to dealmwith the circumstances, however unfair they may be.
I won't discuss billing unless I'm asked. If I'm asked, I tell them what I believe to be true. If I think telling them off the record that (if I were them, hypothetically) I would refuse txp after the eval, and take myself to the ED or urgent care instead of getting a txp bill would benefit them, I may do so.
If someone calls 911 and thinks it's free, I have no remorse. If the pt is an immigrant, they may not realize that we charge, as they may not get billed back in their country. In that case, I'll mention that fact. Usually, the immigrant will either be insured, or not care about a bill because they have no intention of paying it anyway.
