Do you discuss costs?

[Ridryder 911]

If anyone uses the cost of the ambulance bill to be a aid to get a patient to refuse is out of line. I know it's never happened right?

I routinely do this. If the patent's condition warrants true emergency medical intervention then I will discourage discussion, placing life over costs. If the condition is not a true emergency and can be handled per taxi, non-urgent care centers then I will emphasize the costs. Never refusing care or treatment, rather informing them of their options.

R/r 911

[TheOldMan]

If we are doing a routine transfer, and the patient is deemed to be ambulatory in their physicians eyes, and the patient is a medicare patient, we are instructed to provide them with a cost, and make the patient aware by signing a ABD (Advanced Benefit Disclosure) form, detailing why medicare may not pay for this transport, and informing the patient of the cost of the transport, and asking if the patients still wants transported, having the patient sign the form, and making sure the patient understands the decision. My opinion, if the patient asks, I tell them, of course I may be off a dollar or two, but I am usually close. I feel if the patient asks, be honest and tell them.

[sirduke]

I had a patient a few days ago that called us out for "loose bowels" and upset stomach. While she was vacilitating about whether or not to be transported, she called her boyfriend to drive over and bring her a soft drink to settle her stomach. My partner explained to her that the transport would not be covered by Medicaid, and her response was "I ain't paying for it anyway". My partner asked her why if her boyfriend could drive over (appx 4 miles) the why could she not ride with him to the hospital. Her reply was he didn't want to waste his gas when she could get it for free.

[Chief1C]

Whether or not they pay, doesn't affect me either way.. So, I don't and I won't discuss payment terms. We use a third-party billing agency. All of that is between the patient, their insurance and our billing agency.

[Christopher.Collins]

In the private service I worked for we wernt forbidden to talk about cost... but we had no personal knowledge of billing as techs. Usually if a patient asks we simply say that any questions can be directed twords our billing department.

However during non-emergent transports a patient or family can request a quote for the transport which is usually given to us by the shift supervisor or dispatch. Prior to loading the patient we give them the quote and a special refusal and insurance form in case they decide not to use our services. We could also call dispatch for a quote if the patient or family was very insist upon a quote.

Personally however, I do my best (for patients that need an ambulance even non-emergent transport) to convince them that their health is more important. Kinda like every time I buy a pair of cheap sunglasses the guy is always like can you really put a price on your vision? Only Im alot more tact and compasionate to my patients than a salesman. By the way I can put a price on my vision, my aunt is an eye doctor, so I get stuff cheap anyways.

[TheOldMan]

Whether or not they pay, doesn't affect me either way.. So, I don't and I won't discuss payment terms. We use a third-party billing agency. All of that is between the patient, their insurance and our billing agency.

Do you work for a tax-based service? If they don't pay, how does your company make money to give you a pay check?

[zzyzx]

In the three California counties that I've worked in, no one ever tells the patient up front what the cost of the service may be, unless they ask.

I was listening to a radio talk show the other day. They were discussing EMS. One person called in saying (I'm paraphrasing), "I didn't have insurance or a regular doctor, and I was at the pharmacy seeing if I could get something for some abdominal pain I was having. The pharmacist suggested I just call 911. I called them and asked the dispatcher if I should go to the hospital, and she said, 'Don't worry, I'll get an ambulance to help you out.' A little while later, all kinds of people showed up, firefighters, paramedics. The hospital was only two blocks away and I could've just walked there, but the ambulance people said, 'Don't worry, we'll just take you there.' Well, a month later I get a bill for a thousand dollars from this ambulance company. I was really upset. It seems to me like they are just concerned with trying to transport as many bodies as possible so they can up their profit."

[Just Plain Ruff]

I hope by my previous posts that it was not misunderstood that I told the patient what it costs for the trip before we transport. I always told them if they asked but I never volunteered the info.

I say if they ask you tell, if they dont' ask don't tell.

But for those frequent fliers who you know are faking - ham it up. tell em that the service charges XX dollars and if you don't pay they wont' transport anymore. Tell the abusers that there is a credit limit for the services we provide and if they go over their credit limit then they have to pay cash or no go. This works really really well for those who are so drunk that they can't see straight.

I hope you recognize the above was a joke?

[letmesleep]

Although most of us here (at my district, myself excluded due to recent research for posting in the "city") don't know what the pricing scale is, we do inform the Pts of a price range, and also explain to them not to quote those prices due to the fact that we are NOT involved in the actual billing process. It is standard practice here to inform the residents that there is a cost for transport (when a non emergent transport is warranted, and we have the time), but before we go any further with transporting, we will suggest other options.

My personal opinion in this matter is that in EMS we are forced to wear many different hats out in the street. When it is allowed we need to inform our Pts about everything that they may experience in the next hours/days of their lives. We need to be as up front with our Pts as possible about cost, not just because Medicaid states that we HAVE too, but because that is part of our job. At the point that a non-emergent transport in recognized our Social worker hats should be put on to figure out what is going to be the best means of transport for our Pts. Like it or not it our responsibility to educate (as professionals) the public about OUR different systems as best we can. I have found in my time in the street that honesty, no matter how harsh it may be, is the best policy, and the level of respect that WE all demand will rise from this. I once told a boss that it is NOT my job to make the residents of this district poorer than they may already be by NOT educating them and allowing them to make an informed decision.

BTW, Ruff, what the hell happened to the dog?

[Chief1C]

Do you work for a tax-based service? If they don't pay, how does your company make money to give you a pay check?

:roll: