Find other individuals. Band together and take collective action.
By yourself? You can’t. (I mean, you could do what I did and emigrate, but that seems extreme.)
I don’t think it’s a matter of can’t do it much as someone doesn’t want them to. Either the hospital or the doctors or perhaps the insurance companies .Because there is one hospital I have been to where I did not get a separate bill for the doctors - I think it was because in that hospital, the ER doctors were actual employees of the hospital.
If the ER doc or anesthesiologist is a direct hospital employee then you’d only get one bill but if they’re part of a separate group you’d get a separate bill. Given the large percentage of ambulance services that are not hospital affiliated I’d assume that you’d continue to get a separate bill for the pre-hospital vs. in-hospital services.
Whoops there was something else I meant to mention in that post - I have in the past had (unaffiliated) lab charges for a biopsy added to a doctor’s bill. In any event I’m not saying that they don’t bill separately , just that it’s because someone in that equation wants it to be that way. There are lots of situations that work the other way - my dentist pays the lab that makes the bridge or my doctor pays the company that makes my prescribed orthotic and then I pay the doctor or dentist.
I do my part. I never submit to a test/treatment/whatever without first knowing if it is covered by my insurance. I’m sure I’m a pain in the ass for the doctors/nurses/administrators, but fuck ‘em.
When I was being discharged after my stent, the nurse brought my morning dose of medications. Realizing I’d be picking up scripts and arriving home in a few hours, I asked the cost and refused them when the answer wasn’t forthcoming.
If you just sit back and do as they tell you, they’re gonna rob you blind.
Upthread ambulance bills of 1280, 4000 and 2300 USD were mentioned.
That made me wonder what ambulance services in Germany bill. That is not immediately transparent to me as an end consumer because of course everyone (except for some edge cases) is insured and only pays the 10 EUR copay.
I found that this report (German language) from the site of public broadcasting station MDR. According to that report the standard amounts that the ambulance services bill to insurances for an emergency call with transport to hospital range between 324.01 EUR and 971 EUR over three east German states (the regulated price varies between cities and country districts because rural ambulances sit idle most of the time - there have to be more of them over a rural district to meet statutory response time limits, but the population served is much thinner on the ground).
That’s 324 EUR to 971 EUR per emergency call standard tarriff which covers all costs tor the nonprofit ambulance services tasked with ambulance provision.
Perhaps the key word there is non-profit?
It’s not non-profit vs for profit, it’s big costs (see post #13, above) & needing to break even & the paltry reimbursement rates from insurance companies; especially Medicare/Medicade
Why insurance reimburses such a small percentage is a bigger issue than just EMS. No one with insurance pays rack rate for medical services, it just the poor schlubs w/o insurance that end up with bankruptcy inducing bills.
You have to keep in mind that a lot of those charges become bad debt - someone gets and ambulance and simply doesn’t have the money then the ambulance company simply is out that money. Likewise, if someone dies it might not be possible to collect from the estate.
Therefore, one reason US ambulance charges are higher is because the services have to charge people who can pay sufficiently to compensate for those who can’t/don’t pay to keep in business.
After having two ambulance rides last year I found our local ambulance service will cut 40% off your bill on the spot if you can pay the rest of the total upfront all at once, further complicating the picture.
If an ambulance company was guaranteed that they would be paid for every single ride without having to deal with insurance companies or having to chase people down to get them to pay the per-ride cost here would most likely be less. May or may not be as low as Germany, but it would almost certainly be less.
In Canada ambulances are usually a municipal concern and use taxes to cover expenses. This, ambulances that transport patients to hospital are paid. Paramedics have a stressful job, for sure, but the pay is not terrible. Private ambulance companies exist for non-urgent transfers and transportation. People using public ambulances for egregious reasons occasionally receive a bill for several hundred dollars. Possibly people from outside a certain area are charged as well on occasion.
Current Rural Volunteer FF and WA NREMT-1 (national registry EMT, basically my cert is good in like 40 states)
A few answers, elaborations, and corrections to some things posted in no particular order.
Typical certifications here are
EMR: Emergency medical responder (basic first aid/CPR)
EMT-1: above plus… Far more advanced first aid, some basic anatomy/physiology, more extensive patient assessment, 5-10 medications depending on jurisdiction, AED use. We can take Blood glucose.
EMT-A (advanced) above plus IV access and a few more medications
EMT-P (paramedic) above plus about 50 medications, endotracheal intubation, EKG interpretation, manual defibrillation, cardioversion, intraosseous lines, needle thoracostomy, probably half a dozen other things I cant remember right now. They have elaborate protocols for ALOT of things and are generally allowed to operate without base hospital contact as long as they are within protocol. Our guys are usually calling in for instructions when they are running out of protocols and looking for any additional options.
Because EMT-1s handle medications, the expectations bumped up a bit. in our case we are expected to practice at the full extent of our certifications which does include a broad variety of assessments and signs/symptoms. Us being able to be as accurate as possible with the tools we have on hand is a big deal when we are often deciding between a very limited local hospital, hour plus ground transports to better equipped hospitals, or helicopters to Seattle.
My EMT class was 14 hours a week for 12 weeks, so 168 hours. Its a pretty intense class schedule and plan on bare minimum of another 10 hours a week of reading and study that you’re expected to be familiar with before the relevant class time. So call it 300.
I work in a hybrid department. Part paid, Part volunteer. 9 stations Only 4 are staffed full time. The rest are basically apparatus storage for rigs run by volunteers. About 18 paid FF on duty at any given time including 3-4 paramedics plus 40 volunteers who may or may not respond. Many critical support tasks are covered purely by volunteers namely breathing apparatus recharging, rehab, and water tenders.
As a rural guy who often responds in my own vehicle, I am often on scene 5-10 min ahead of the closest career crews. I will do most of the initial assessment and vital signs about the time they arrive.
We use a methodology called “Sick/Not sick” for me to make a quick determination of more or more advanced resources may be needed including helicopters. So in the case of a high acuity patient, I can have helicopters airborne before the paramedics arrive.
We have BLS/EMT-1 only ambulances also that do respond to a variety of calls with no paramedic support unless they ask for it. Many less medically complex calls are handled by these crews with no paramedic present. Probably only about 25% of our calls technically require Paramedics.
I was on a call recently that was handled by two volunteers we cancelled the inbound career crews.
I cant speak to Canada but Firefighters in most paid departments in the US are required to maintain EMT-1, volunteer organizations are a little more flexible.
about 70% of the US is covered by volunteer fire departments with varying degrees of funding. Some have all new shiny stuff, some squeak by with 30 year old rigs held together with duct tape and bailing wire.
Training wise I have about 40 hours a year of required training and practical testing for my volunteer FF side plus a monthly drill session for 3-4 hours and 20 hours of continuing education required per year plus some required skills testing for EMT. Much of it is online, and goes a bit faster than the “credit hours” imply.
I probably average about 12 hours of active participation in 911 response a month.
I think our department runs well and we have a solid core group of volunteers that keep things going. Our command level folks all seem rock solid to me. As far as funding and such I don;t know much other than I know we are having a bit of a shortfall this year but we are also buying 3 new pieces of apparatus, one new ambulance and another ambulance is going to get remounted on a new chassis.
Any particular questions, feel free.
There was precedent for what you suggest long ago. in my private ambulance days 1989-1992 we had such and arrangement for NICU transfers. The hospital apparently started running into challenges with insurance declining paying the hospital for transport but hospital still being obligated to pay us. They stopped paying us when they encountered it leading to a giant messy court case. That little kerfuffle ended up killing that ambulance company.
Just as a point of reference. Floor staff in a hospital normally have zero idea what things cost beyond a few basic things like maybe daily room rate type things. They never have the full picture.
We have access to a helicopter membership/service plan. Its like $100/year for he household. Not a horrible deal really. Especially when ground transport can take 2 hours and involve car ferries.
How are your calls dispatched?
We have a central 911 dispatch center that handles police, sheriff, and fire/EMS. We don’t have any private ambulance services in our county, it’s all fire department.
I think those are call takers. How are you and your colleagues directed to places of need? Do you report your status as updates become available: responding, in transit, on scene/fireground, etc?
In our case the people answering all 911 calls are also the ones talking to us on the radios. There are only 2-3 on duty so they multitask a lot.
The Anatomy of a 911 call/Response for my agency. There are a lot of moving parts that can happen here so I will try to keep it coherent…
911 call received, basic information on nature of problem is collected and entered into a
computer aided dispatch system (CAD).
How many and what type of units is determined via a little flow chart.
The nearest available units of the appropriate types are alerted aka “Toned out” *
Units report to dispatch center via radio as they roll out and or arrive on scene. **
Units participate in call***
Units advise dispatch as they initiate transport of patients, request air transport. or become available for new calls ****
[*] The series of tones you hear on many EMS radio channels is part of a system that triggers audible and visual notifications at fire stations. Those alert tones can do lots of neat things like turn on lights in sleeping quarters, common areas, and apparatus bays, turn on speakers so current dispatch communications can be heard throughout the building as we roll out of bed and head for our rigs, even trigger door openers on apparatus bays. Volunteers are primarily notified via phone apps integrated with the CAD system so we have an idea of the nature of the call, the location of the incident, and the units assigned. We have a list to choose from in the app of when to be notified associated with what stations or units are being dispatched. Usually volunteers have a station they are loosely assigned to and any incident near a volunteer station will be tagged in a call to notify volunteers assigned to that station.
[**] As there may be a bunch of volunteers responding we don’t individually report as enroute as we could easily become a giant swamp of radio traffic. We only call in via radio of we are the first to arrive on scene in personal vehicles or if we are responding in fire apparatus. So if there was a call for a fire that needed water tenders, I head for my designated station in my personal vehicle. When I roll out in the water tender, I would call on the radio and say “Tender X enroute [call location]” and then “Tender X On scene” or “Tender X Level 1” When I arrive. “Level 1” = staged nearby, usually within a couple hundred meters. Out of the way, but available in <1 min.
[***] dispatch has several data collection tasks and relays information as needed during an incident. On larger incidents they have a big contact list for neighboring fire/EMS services as well as a variety of county and state level agencies where appropriate. They also have the ability to relay phone calls to our command staff so calls from those agencies have a common point of contact.
[****] If air transport is needed our dispatch calls helicopter service dispatch center via phone and advises our on scene personnel of ETA of helicopters when they are enroute. We have a bunch of predesignated landing zones where we typically meet helicopters. Depending on circumstances there is significant flexibility. We have landed multiple helicopters right on a freeway next to a serious car accident. We are in a fairly rural area on the west side of Puget Sound with limited hospital facilities. Critical patients are often flown to places on the east side of the sound like Harborview Medical Center in Seattle. Helicopters can cover this distance in minutes vs hour+ for ground ambulances.
Ambulance services are often part of elaborate contracts with the city/county they operate in. Some of those contracts specify a minimum payment, say $50 from the municipality in the case of folks with zero ability to pay (example: a homeless person gets very sick and dies enroute to hospital).
Where these contracts are competitive and or exclusive, it is not uncommon for the ambulance services to ask for zero compensation to score those contracts then try to squeeze the patients later. If you wanted to see a law that would help stabilize ambulance services in general. Having a minimum guaranteed payment for such services from local government or Medicaid/Medicare would probably make a huge impact. unfortunately these zero bid contracts look very good on budgets so short of federal legislation, I don’t see it happening. You could get a lot of bang for your tax buck just not having to struggle to squeeze every patient for a minimum payment to at least break even on some medical supplies, fuel, and maintenance.
I work for a fire department that runs local EMS. We charge for people we transport. I don’t know the specifics of our charges and we are discouraged from inquiring as they want us to focus on patient care not the potential bill we are generating. Situations where folks decline transport or assistance helping a limited mobility patient back into bed or wheelchair we do not charge for.
My last cab, I mean ambulance ride in the USA was operated by the niece of my sister-in-law, who had torn up my prescription for Libtrum (a sort of cousin to Benzodiazepine) that’s often used to get through those first days of alcohol withdrawal (which can kill you). I was shaking and really could have used that stuff or a drink, yet they dropped me off at the Hospital ER. So it was a cab ride. I lost consciousness, don’t know if I had a seizure yet this was the only time I had Delirium Tremens. I later heard I was taking people in the ER’s cell phones. And I definitely recall later wandering around inside the patient area and recognizing everyone I saw (a hallmark of the DT’s).
I really should have sued them. This was over 10 years ago. Yet I was on Medicare else all the bills would have been $15K (in cash).