Why have a volunteer Squad when the ALS patients keep getting turned over to the Paid ALS service…….

I belong to a Volunteer Rescue Squad which is part of a Volunteer Fire Department. Over the past 2 years we have had a paid ambulance service come in and handle daytime calls, due to our members not being around during the day to get the ambulance out if a rescue call came in.

Okay that is a little information so you understand how this went down. We had an EMS call this morning, so the paid ambulance was out on that call. As I was walking into the post office we were dispatched, along with a backup ALS unit, for a possible stroke at a residence in our town. I went to the firehouse and got the rig. I waited for another crew member and was informed by my Rescue Squad Captain to respond in and she would meet me at the scene. I had another member call in and report on the scene but he wasn’t able to go to the hospital, as he had to go to a college class. When I got on the scene I took the stretcher and crash bag and went into the apartment.

I was given a report by the patient’s home health aide that she had fallen out of bed last night and hit her head; the patient presented with a contusion on her head. The patient is also a diabetic, and her blood sugar (tested by her aide as I arrived) was 368. According to the aide the patient’s blood sugar is always erratic. The patient also has an inoperable brain aneurism, so the fact that she struck her head during the night was making me a little concerned. The patient also was having blurred vision and dizziness, and weakness on the left side. The patient’s blood pressure was within normal limits.

I was about to start getting the patient ready for transport when my Captain came in. I gave her a quick report, asked if she could go to the hospital, and told her that I could also go. She informed me that she could go, and then asked where the medic unit was. I told her I didn’t know, and she went to find out. She came back in and told me the medic unit was advising they were approximately five minutes out. When I said “let’s get the stretcher and get going” I was told “no”; that we could wait for the medic unit and they could transport the patient. I was in shock and disbelief that we were waiting for the other unit and not meeting them en route. I was not happy with the decision but was over ruled by my officer. The medic unit came and we loaded the patient into their rig and off they went ALS with the patient.

As I was getting ready to turn my rig around my captain stopped me and explained that the reason she turned the call over to the other unit was that the patient’s insurance company wouldn’t pay the bill if the medic came in our rig, but would pay if the patient went in their rig.
I questioned her about it in disbelief and told her she needed to get that whole idea out of her head. She insisted that she couldn’t have it where the patient gets sent a bill and has to pay the bill because the insurance company won’t. I gave up trying to get an explanation or getting the point across to her that the billing with the insurance company doesn’t matter.

This upsets me because this same officer has recently discussed us taking back more daytime shifts from the paid service and yet here was a call we handed over to them. Would we have done a meet and assist? Yes for sure. That still doesn’t mean we give the call totally to them. How does this make us as the volunteer squad look to the public? Not good in my eyes. I am at the point of, why are we here as a volunteer squad, if we are going to turn the patients over to the paid service for transport. I just don’t understand and feel that waiting for the other unit is delaying care to the patient. That’s wrong, by any training I’ve had…and if something happens while we’re waiting, then we could be in trouble over the fact that we waited to transport.

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Permalink Reply by FETC on February 7, 2009 at 3:10pm

The fly car is dying because you want ALS for free. Laws don't allow the fly car to bill the insurance company. So the private services currently bill the patient directly, then chase them til they die. Like I said 1000-1500 dollars is the norm for a lengthy ALS transport. They are switching to ALS Ambulances for one reason only, recouperation of money. They will be able to bill the patient's insurance if they transport. The next step after the transition will be "give us the patient" on an intercept.

Our ALS Ambulance Service costs our taxpayers a 1/2 million dollars annually. Of which our taxpayers are paying for and if you live in a surrounding community you expect that service from us for free? Cost recovery now is almost a wash! but it wasn't always that way. Bottom line is this is a business regardless of the status of your organization... you have a budget just like a CEO. We are ALL in the service industry.

I am sorry but like I said you got choices now: (with us)

1: Don't call us; and give the patient what they are really paying for... BLS
2: Agree to pay for it from your budget. Your numbers are on. Some towns budget for it now.
3: Turn over the patient to the paid service, costs you nothing, and let them bill the end user.

Here is how the breakdown happened after the new system went into effect.

Nobody chose #1.

Some chose #2 with us... started billing patients and we respond with a flycar. But they trained there personnel to only call for an ALS intercept when it is truly needed. Fine by me but they still pay for the service and in turn recoup the ALS charge by charging ALS transport fees. Even wash...

Others chose #3 , will never start billing their townspeople, we respond in the ambulance, take the patient from them. Now we seeing a dramatic drop in first responder response because, hey we are not needed here anymore.

I would question the wording of your statue above, can you bill the insurance company because it says "without cost to the person served"

If not, then a few calls to policticians to change this old law will resolve the issue in these economic times... the politicians are looking for ways to cut government costs... insurance companies should be footing the bills not the service

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Permalink Reply by Joe Stoltz on February 7, 2009 at 3:44pm

Do you have the particular federal law number handy? I did a search of the CFR and got a bunch of stuff back. Found some possibilities but my eyes started to glaze...

I would have thought our ALS fly car would have enlightened us to this law, or complained, or gone under before now. Or perhaps been discussed when we met with the CEO of the organization the day before yesterday.

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Permalink Reply by FETC on February 7, 2009 at 5:41pm

I don't know the law# specifically. All I know is it was against the law to bill the patient for ALS charges if you weren't the transporting agency. Our city attorney advised our fire chief to stop billing the patient for ALS flycar services.

After research, he was advised the only way to continue ALS intercept cost recovery was to bill the individual town for ALS services accepted or we could simply transport the patient in our rig to ease the billing process.

Now if your flycar is private, they are not as worried as they bill the patient directly even if they do not perform the transport. Directly, meaning they send the bill in the mail to the patient and they in turn have to ask their insurance company to pay the bill. Now if the patient doesn't pay or the insurance denies the claim, then the private ambulance (a for profit business) will turn it over to collection agencies or hound the patient themselves for payment.

It will be much easier, far less headaches, and increase cost recovery, if they could bill the insurance agency directly without going to the patient first. But they can't because they didn't transport the patient.

I am not saying they will say, we want to transport the patient in the future... I am just saying I have seen that tactic eventually rolled out before...