The "List"

[FireMedic65]

I have been around quite a few ambulance stations, and I have noticed that most of them have a "list". This list consists of people in the coverage area that do not pay their bill. When I asked about it, the answers I got were "oh, so we know who not to transport or respond to".

Is it just me, or is this just morally wrong?

[spenac]

I have been around quite a few ambulance stations, and I have noticed that most of them have a "list". This list consists of people in the coverage area that do not pay their bill. When I asked about it, the answers I got were "oh, so we know who not to transport or respond to".

Is it just me, or is this just morally wrong?

If these are 911 services I would say that it is probably illegal and definitely a lawsuit in the making. So I say it is morally and ethically wrong.

[Dustdevil]

You say "ambulance station", but don't really tell us what that means. Obviously, with a tax funded 911 service, this would be a serious concern. With a private, non tax supported, or non-emergency service, that's their prerogative, although you could certainly find a crooked lawyer to maintain otherwise.

What I have ethical concerns with is people who utilise a service that they never have any intention of paying for in the first place.

[Kiwiology]

We don't have a "list" per-se because we're rather liberal with the billing (last year we wrote off about $3m which didn't get paid) but we certinaly do have a list of the VIP customers

[FireMedic65]

I say "ambulance station" because I have seen them at several different places, being volunteer, paid, private, county/city run places.

[Katiebug]

Wow. That is a question that has really good points on both sides.

I work for a municipal 911 service that does not bill for DNTs. As a result, we get a lot of, "I just wanted to get checked out", or "His sugar is just low. Just wake him up and we'll take care of him". I get lots of refusals AMA just because they needed my advice on how to handle an issue.

We have a few pts that call regularly for assistance with things like, "I can't get off the toilet", or "I'm having an anxiety attack".

Our chief has told these people that if they continue to call EMS for these issues and sign refusals, they will begin recieving bills for our services. Now, while I am pretty tired of responding weekly to these same people for these same issues, it's still not fair to bill them. Why? Because we still don't bill anyone else for DNTs. These "frequent flyers", if you will, are not abusing the system. They really need help. They just don't need to go to the hospital. A nursing home maybe, but not the ER.

Now, I work for a tax funded, municipal service. I have a responsibility to the general public to make good on what they pay me for. Let's say for the sake of argument that I owned a private service that relies on payments for services rendered for my livelyhood. I have to pay an EMT and a paramedic, fuel,vehicle insurance, malpractice insurance, maintenance, overhead (building rent, utilities, uniforms, supplies, overtime, continuing education, health insurance for employees), taxes, Accounting, etc., etc.

As most of us know, most private ambulance services survive off of Medicare. Medicare only pays about $200 per transport. So if I am transporting a patient that can't or won't pay for my service while I could be transporting a patient that does pay, then I'm really losing twice in one transport. I'm not making that much per transport anyway. My survival depends largely on volume. As a private business, it is my responsibility to my business and the people that work for me to remain financially sound. Otherwise I'll have to close my doors. It's just survival. Although I do understand where you are coming from.

[Chief1C]

I expect that most of the people we cover can't pay the bill. That's what you get in poverty stricken, rural areas. But I certainly wouldn't deny anyone their right to quick emergency medical care, just b/c they can't pay.

[FireMedic65]

See, that's what I am saying. I won't deny anyone care/transport if they need it. But a few places I have been, I have been told, DO NOT transport these people... DO not respond here... I am like... woah, what?

[Katiebug]

4C6, I agree. It would not be ethical to deny emergency care to anyone. If it's an emergency call. I say again that there are valid points on both sides of this argument. What about routine transports for people that require an ambulance? Who should transport them if they can't pay? Me, as a tax funded employee? A privately owned ambulance service? As a society we have a responsibility to our fellow citizens, but who should fund it? Nobody does anything like that for free for long. They just can't. As a matter of fact, is it ethical to require a private business to respond to emergencies for free? Where is the line?

[Richard B the EMT]

See, that's what I am saying. I won't deny anyone care/transport if they need it. But a few places I have been, I have been told, DO NOT transport these people... DO not respond here... I am like... woah, what?

Do not respond? Do not transport?

Whoever issued those orders, best rescind them. If it is an actual order, it sounds like denial of service to a person who needs it. Can you say "Lawsuit"?

Then, again, I work in a system where we treat/transport without asking for ability to pay, either by Medicare and/or Medicade (state and federal assistance), third party insurance plan, or cash. When we bill (from FDNY EMS Command), if there is no insurance, we send a bill directly to the patient's recorded address, with instructions on how to arrange for the insurance carrier to pay, or send a check in the amount.