I just checked how our NHS classifies staff in the ambulance services. There’s the same distinction between an EMT and a paramedic, but also other grades:
https://www.healthcareers.nhs.uk/explore-roles/ambulance-service-team/roles-ambulance-service
Hard to say if this will pass.
A committee chartered to find ways to stop ambulances from sending patients exorbitant bills is set to tell Congress that patients should pay no more than $100 or 10% of a bill, depending on which is less.
The recommendation, which still relies on the convoluted private insurance industry, comes as nearly half of all ambulance rides in the US result in a “surprise bill” of often hundreds of dollars…
…Surprise bills are in effect a dispute between insurance companies and healthcare providers. When a person takes an ambulance that is not directly contracted with an insurance company, they can bill insurance any amount they please. The remainder of the bill is then the patient’s responsibility. Hence, surprise bills are often called “balance bills”. And they can cost thousands.
I moved into an apartment where a friend’s father had died. We got bills for his final ambulance ride for years. They were insane, for a two-mile ride. The father’s executor had notified all creditors, waited the legally mandated time, and closed the estate before the first bill came. The ambulance company was very aggressive about it, and then pushed it to an equally aggressive collections. The executor told them to stop, and why, but they did not. Ultimately, these aggressive tactics didn’t work, as the dead man was dead and his assets disbursed. The whole thing was a clear indication that something was very wrong with the system.
TBH at this point I’d be shocked if there was an aspect of the US healthcare system that wasn’t set up to screw over patients in the most Kafkaesque way possible
When my father’s COVID got suddenly worse and he had to be taken to the hospital in an ambulance, the first thing he said to my sister on regaining consciousness was “Did I come here in an ambulance?” He was very pissed because he knew he was going to get a huge bill.
Sure enough, he was “balance billed” $2300. The county subcontracts ambulance services to a private company. They are in-network for no one. Their Medicare Advantage plan argued that he did not need an ambulance. He could have been taken to hospital by car or Uber. They paid $150 in the end and the Ambulance company agreed to close out the billing.
An 85 year old unconscious man who hasn’t walked for several years without a walker due to Parkinson’s was expected to take an Uber or taxi or find a family member to drive him to the hospital after collapsing and struggling to breathe. My frail 85 year old mother who was also ravaged by COVID spent hours and hours every day on the phone arguing about billing and authorizations for five weeks after the incident.
Running an ambulance service is expensive. It often costs more than $100 for a ride to the hospital for just fuel and medical supplies, much less the cost of labor for the EMT’s. If patients only pay $100 who is going to pay the rest? Because if the rest isn’t paid those companies go bankrupt and then you no longer have ambulances.
- Insurance companies
- Hospitals (i.e. the hospital visit starts when you enter the ambulance, since that’s where you’re going anyway)
- Government (via taxes)
That’s what I thought at first. Turns out the bill sent is a mismatch between what the insurance company thinks is reasonable and what the ambulance or hospital does. This hundred dollars would not be the only payment, just extra to insurance.
I had a young trauma patient in the ER requiring immediate neurosurgery in a Canada border town. There were no available neurosurgeons in the entire province. I was able to find a big American hospital willing to accept the patient. Under these desperate circumstances, the provincial government magnanimously agreed to cover the much higher American costs of surgical care, with the understanding as much rehab would be in Canada as possible.
The hospital suggested an American air ambulance company. They flew her ASAP and she survived and thrived following a very serious accident. The government paid the hospital costs. But this company sent the family a $50,000 bill, which the government would not pay. The family was upset, and in the end our hospital generously paid it.
NO ambulance service in my county is “in network” for any insurance company. None. Many US health policies pay $0 for out-of-network costs.
In the US? Ha-ha-ah. Especially for Red States.
The answer of course is a Federal law that all insurance covers all ambulance rides, including helicopter if needed, as a normal in-network charge regardless of any other considerations.
Never happen, but that’s the answer.
One of my gf’s aunts and her husband have separate insurance policies to cover helicopter transport for medical emergencies.
A few years ago, the aunt was up in her attic hanging up laundry to dry. (Their HOA doesn’t allow them to hang clothes outside). She took a misstep and came crashing through the ceiling, down into the kitchen. Her husband frantically called 911. When an ambulance arrived he mentioned they had life-flight insurance, so they arranged helicopter transportation.
When we heard the news that she was flown to the hospital, we assumed the worst. We were just leaving for the hospital when we got a phone call telling us not to bother. She was treated and released. Shaken up, a few bruises.
New to this thread and noticed there was no reply to your post explaining why everyone showed up. Phone call to 911 - “Smoke in the furnace room”.
Standard practice based on years of experience - assume the worst. When we (FD) arrive there will be fire through the roof and we be there all GD day pulling out bodies.
What happens 98% of the time - minor issue, food on the stove, etc, etc.
BUT if it’s the 1 or 2% where the fire is through the roof and bodies are jumping out of windows and doors, it’s better to have the equipment on scene or at least on the road, instead of calling back and saying HELP.
As a former volunteer Fire Chief I know it’s a lot easier to turn away unneeded help then to start hollaring for more ASAP.
Good point.
I was a little surprised when most of them didn’t turn around and go back to the station once it was clear that the fire was nonexistent, and that all household members (except one of the budgies, who was not cooperating with getting into the travel carrier) were outside and safe.
Amusingly (for varying degrees of amusing): the incident led to us being without air conditioning for several days while the replacement motor was being sourced. Our AC died again yesterday (and we are awaiting the repair person). I’m thankful this did not happen a week ago, when the heat was truly dangerous - we’d have had to move to a hotel for a few days.
From what I’ve seen, while observing the fire department in my city, they may take the opportunity of being called out to a fire to practice pulling the hoses out, laying them out and so forth. They may be taking the opportunity to give the rookies some practice.
While there are some hospital-based EMS services in many locations they are not affiliated. EMS should take a patient to the closest appropriate facility, that may include literally driving past one hospital to get to another especially if you’re taking someone to a dedicated trauma center or stroke center vs. the local general hospital.
When there are two hospitals that are equidistant I’m gonna take you closer to home base so that I either get back & leave sooner or am able to turn around quicker & take the next call.
I’ll just add that with a volunteer dept you don’t know what you’re going to get at any given time. 10 mins after scheduled training is to begin the apparatus will be filled; at 6am when many of the volunteers are getting ready for/going to work not so much. With a paid dept you’ll always get a full compliment but also fully qualified to do whatever their assigned task is that day. We have some that are only exterior-qualified & can’t go inside the burning building, & some guys who don’t feel comfortable on ladders but can do other tasks on the fireground. The run cards are frequently built with this in mind & may dispatch a couple companies to ensure you have a full compliment of qualified & comfortable firefighters if it is a fit-hits-the-shan situation.
I don’t understand the point about different hospitals. Surely the bill for the hospital stay could include the payment to the ambulance that brought you? Hospital pays, and passes costs to patient. It’s the one thing they’re good at, besides possibly medicine.
Do hospitals ever offer kickbacks to ambulance companies? I was wondering about this and apparently it has happened.
If you go to the ER you’ll frequently get two bills, one from the hospital ER & one from the physician who treated you. I don’t begin to know the laws but if the hospital can’t take your payment for the doctor who treated you in their facility & pass it on to them I’d assume that they can’t take payment for EMS who brought you there & pass it on to the ambulance service.
Interesting. Why people put up with this is beyond me.
How do you suppose I as an individual can stop “putting up with this”?