A guy I know came close to fainting a couple of months ago and well meaning people called for an ambulance. When the EMTs showed up, he insisted that he was dehydrated and needed a drink, but they insisted on transporting him to the hospital. In the condition he was in he could not resist them. At the hospital, they hooked him up to an IV to get some liquids in, and ran a bunch of tests which showed nothing wrong, and they released him after an hour or two.
Then the bills came in. His insurance paid most of it, and he was OK with paying about $100 for his share of the hospital bill. But his share of the ambulance/EMT bill came out to about $600, which he found galling since he hadn’t wanted these guys’ services to begin with.
So the question is: what is the legal responsibility that a person has to pay for emergency care bills that he never wanted to incur to begin with?
If the person does not have to pay the ambulance bill unless he gets a ride, I assume the EMT are motivated to ensure they have a passenger at the end of a call-out.
We see this sort of question around quite frequently. Obviously, if you avail yourself of their services, you are on the hook for the bill. The potential patient may not be completely comprehending their situation. I’m not sure what the EMT’s responsibility is, other than to ensure they do not walk away from a problem and possibly end up with a lawsuit (“The guy was sick. You should not have left just because he told you to.”)
It certainly sounds like he DID need immediate IV fluids, based on this snippet (and your overall description). Unless he was with a friend or family member that could immediately transport him, it was the ambulance or nothing. The EMTs can’t let nothing happen in those circumstances. If he was too physically weak to walk away from them under his own power, get in his car, and drive off, then he actually needed the ambulance. I’m sorry our medical system hasn’t yet evolved with the rest of the first world’s, but what would have been his preferred alternative?
You have to understand it from the flipside (well, he does anyway). If he was so severely dehydrated as to almost lose consciousness and attract the attention of well-meaning bystanders, then there’s a risk it would have happened again while he was driving to the hospital. Drinking water in that situation may not have been enough. I’ve been severely dehydrated, not even to the point of loss of consciousness, and I was in NO state to drive. It’s definitely a medical emergency.
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We see this sort of question around quite frequently. Obviously, if you avail yourself of their services, you are on the hook for the bill. The potential patient may not be completely comprehending their situation. I’m not sure what the EMT’s responsibility is, other than to ensure they do not walk away from a problem and possibly end up with a lawsuit (“The guy was sick. You should not have left just because he told you to.”)
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I don’t know how it works in the US, but in the UK the EMTs can’t just make a call that a customer “needs to go to the hospital” even if they seem conscious and stable and they’re saying they don’t want to go. I know someone who had quite a serious fit; the ambulance turned up and the EMTs did a couple of on-the-spot tests for blood sugar and so on, which all came up normal. The person had regained consciousness by this point but was clearly still out of it (was calling her dog by the wrong name, for instance). But she was refusing to go to the hospital, and despite the pleas of her family members the EMTs said they couldn’t force her to go if she was refusing. You can’t bundle someone into an ambulance against their will just because they look dehydrated or dizzy, over here anyway.
And bear in mind the EMT service and ambulance over here is free and the EMTs work on salary, so money wouldn’t have been a consideration. If you’re bundling someone into an ambulance against their will and then charging them $600 for it I think that sounds even more unacceptable, no matter how dehydrated they look. I doubt that’s the way the US works either - it sounds like this guy did eventually go along willingly.
EMTs in the US are strongly motivated to transport someone to the hospital because transportation services are generally the only ones that they are allowed to bill insurance for. Services rendered must be paid by the person they were rendered too even if they didn’t want them (say a psych hold).
I believe ambulances can take someone against their will if they are a danger to themselves or others. You can see how this might go down the slippery slope from being, say actively suicidal to refusing urgently needed attention. Someone that got shot and refuses to be transported is a danger to themselves, right?
But I’d want more information than what’s given to make any kind judgement calls in the original situation.
In Canada ambulances are one service that is not free. An employer with very good benefits may pay this as a benefit, but in general if you take a ride in an ambulance, it will cost somewhere around one or two hundred dollars. Of course, the medical treatment that comes with or after is free.
Ambulances aren’t free in Australia either. A trip can easily cost $500, thousands if it’s by helicopter. You can buy a membership for something like $50/year that covers all costs. That’s usually included with health insurance policies.
In the US the absolute minimum charge for an ambulance transport is around $500, and virtually all of them are $1000-something. A helecopter or airplane is usually $10,000+. I’m a bit surprised the OP had to pay $600 unless that claim came in before the hospital claim (although usually the reverse is true) and he had a $500 deductable or something. In which case he would have to pay it to the hospital if the ambulance claim hadn’t come in first. In the US Medicare and typical private insurance will pay 80%, so if that really was 20% of the charge that would have been a $3000 for both him and the insurance’s allowed amount, which is really, really high even for a transport of some distance in an urban area.
Similarly to the UK, it’s possible to refuse transport – the paramedics will make you sign a form, absolving them of responsibility. (I can’t remember the ID, but it was covered in my First Aid course.)
Its VERY hard for me to believe the video, but on the slim chance it is for real its so wrong that he should be sitting on a beach in the tropics for as many years as he is alive.
We get refusals so many times and have forms for refusal. As long as the Pt. is mentally able to understand we walk.
In that video situation provided, the Man was of sound mind and I didn’t see anything to question that, we would not be able to transport no matter what his spouse said unless he would go unconscious and then** if she wanted** we would transport even if there is a living will that gave his wishes to not be treated.
One of the most outrageous costs is in a nearby city that has a clinic across the driveway from the hosp/ER and when the Dr. orders a pt. to go to ER by ambulance it cost $1,300.00 to cross the driveway. If that isn’t a stress test I don’t know what is!
People for the most part do not know their rights when it comes to ambulances.
At least that is what i find here in MN.
I figured this out later (as to why the EMTs rushed me to the hospital even after I stopped having chest pains, sweating buckets, and feeling my blood pressure skyrocketing). They thought I was having a heart attack, and I could have been. Turns out it was an attack of biliary colic from gallstones. But there’s no way they could have known that, as they cannot and do not perform abdominal ultrasounds.
In a country where health care is primarily a profit making enterprise, where health corps spend dozens of millions of $$ every year in lobbying fees to influence health related legislation, your friend is responsible to pay his bills.
Since he did not refuse the service, whether because he was comatose or otherwise, he has to pay his bill.
Otherwise the cost of his care will be dumped on his community and conservatives will target him as responsible for the high medical care in this country — unless of course he’s white.
The sober answer is - the person receiving the benefit (ambulance care) pays the bill, regardless of who called it in.
I gather from earlier comments that nobody pays if the ambulance is refused. That’ll be the day, when either (a) you get billed whether you use the service or not, asked for it or not, or else (b) being a good samaritan and dialing 911 could cost you hundreds.
The other moral of the video, is if you start to get agitated around police, you are asking for trouble. Oddly enough, some do not have patience for drunks or argumentative people, and the law generally sides with the police for better or for worse.
The EMT gets paid either way. The ambulance company may not get paid, but the EMT will get paid.
Yes, they can. In fact, they have to let nothing happen. They may not transport a person against his will if he’s mentally competent.
No, not right. People do have the right to refuse medical treatment*, and that includes transport. If he’s conscious, not drunk, not obviously mentally ill and says he doesn’t want to go to the hospital, the gunshot victim has the right to bleed to death in the street. If he’s mentally competent but “a danger to others”, EMT’s still may not forcefully transfer him, they must call the police.
Transport by force or against the will of a mentally competent adult is kidnapping, assault and battery, and those are crimes.
Now, in reality, a lot of people just need a few more minutes to come to grips with the fact that they need to go to the hospital. It’s not uncommon for an experienced EMT to explain the situation, acknowledge their right to refuse transport, and then go sit outside the house in the rig for 15 minutes doing paperwork or checking Facebook. Lots of them do end up taking the transport after all, when the sheepish patient finally admits that, yeah, he needs some help. Sounds to me like that’s more in line with the OP’s scenario. He didn’t want to go, but he didn’t say, “I won’t go; I’m refusing transport. I understand I might die without medical treatment, but I’m accepting that risk.”
This is the way it is in the US, too. I won’t say that forced transfer never happens, any more than I’ll say theft and murder never happen, but it’s not supposed to happen, and the system is set up so it doesn’t happen too often.
Thank you for your informed post.
*Non-pregnant mentally competent adults, that is. Things are different if you’re pregnant or a child.
Insurance here is insane. I saw a story on the news last year about a woman whose ambulance trip to the hospital was not covered because she didn’t get prior authorisation from the insurance company. She said, ‘What, I was supposed to call them while I was unconscious?’
My insurance company (Regence-Blue Shield) told me that an ambulance trip would be covered if the situation is life-threatening. If I wasn’t going to die immediately without treatment, I should call a cab and they’d cover that.
In our rural setting we never refuse to transport. We see the results in the media from time to time where someone die’s after being refused as the result of screening.
We do have a bill in our state that is progressing that would alow for a community Para-Medic to do initial assessments in the field on questionable calls that every service gets and may refer to them as frequent fliers.
A very recent call I was on was for a youth that was sick and vomiting. Mother was en-route to urgent care early in morning and the roads were slippery, it was snowing and there was lots of traffic due to that time of the day. A back-woods “Rush Hour” if you will :rolleyes:
She had to pull over several times because there was no “Cookie Basket” at hand.
Upon assessing this Pt. I certainly didn’t see an emergency and suggested that Mom could continue to transport, but she was to distressed and wanted us to transport. Well we did and I certainly believe an insurance company would do more than deny 2 or 3 times as seems usual in so many cases.
As for insurance’s; There are many differing plans but a common one for those that are self insured there is a $2,000 max and that will look good until someone is transported by air!
A good friend that had a stemi that we responded to.
We are BLS, and requested ALS, ALS confirmed Stemi and requested Air to the Cath lab.
Distances were; Base to Pt. 22 miles.
Pt. to ER 25 miles 20 of it was with ALS on board.
ER to Cath lab 80 miles
We as a system, got this man from initial 911 call to cath lab in under 90 min.
He was billed for all transportation in the area of $18,000 and had a ceiling of $2,000 on his insurance!
