The "List"

[Chief1C]

We don't provide inter-facility or non-emergency transport. I mean, if they call 911, or schedule something special 24 hours in advance we will. But it's not typical. There are services with in a several county region that were once private EMS, and now do nothing but Non-E Transit. I have several numbers, I don't suggest any company in particular, usually rotate around the list when offering suggestions. We get very few BS calls from the rural and secluded areas, it's almost always a true emergency call.

I suppose if you do Transports as a business, and someone just won't pay, you're taking a loss. In order to have a successful business, you need to cut as many of those as possible, to try and get a paying customer. So, from the business side of things. I could see refusing to transport someone. I would see a problem, if they schedule someone, don't tell them they're not getting transported and let them wait and worry. They'd need to work with people to get some sort of payment going. If that's not possible, then yes, I could see refusing them transports; non-emergent, not refusing them emergency services.

[Katiebug]

Refusing care during a medical emergency is unethical. Period. Although it is not always illegal. Usually private services that do 911 have a contract with the county they serve. They are paid a set amount annually and they can bill for whatever they can get. The annual fee paid by the county ensures emergency service to all its citizens. Refusal of a 911 call in this case is illegal, immoral and a breach of contract.

Private services that do not have a contract with the county they serve have a right to refuse service to anyone if there is a valid reason. Non payment for services rendered is a valid reason. It is up to the county to ensure EMS is available to its citizens. That's what taxes are for.

It could be argued here that EMS has a duty to act or that everyone deserves the same treatment regardless of ability to pay and so on and so on. All that is good and fine and very idealistic. It is also socialist. While I personally would help anyone that needed it, if I reasonably could, that reaction from me would be a direct result of my spirituality. As it stands, (for now anyway), we are capitalists here in America and the dollar will unfortunately override compassion sometimes. It's business survival. You can't help anyone if you can't pay your bills. The system needs to be improved, but you can't bash a business for protecting itself.

Edited September 1, 2009 by Katiebug

[Edward]

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?

[CBEMT]

We have a "don't transport" list on the wall in dispatch at my part time job. 100% transport, with some contract nursing home emergencies, no primary 911 responses.

Typically what happens is a methadone patient that usually goes to treatment via wheelchair van will start calling to request ambulance transport for [insert nonsense complaint]. After a while, Medicaid will stop paying for their BS trips, and they can't/won't pay for it themselves.

[FireMedic65]

We have a "don't transport" list on the wall in dispatch at my part time job. 100% transport, with some contract nursing home emergencies, no primary 911 responses.

Typically what happens is a methadone patient that usually goes to treatment via wheelchair van will start calling to request ambulance transport for [insert nonsense complaint]. After a while, Medicaid will stop paying for their BS trips, and they can't/won't pay for it themselves.

I guess that makes some sense then.

[Richard B the EMT]

However, I don't recall any "Debtors Prisons" in existence from the times of Charles Dickens.

[medic15401]

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.

OUR MOTO:

You call, We Haul

Let billing sort out the rest

[wrmedic82]

If hospital emergency rooms have to treat regardless if the patient can pay or not, what makes us any better? It is a known fact that in every system is a system abuser. Regardless, we have to treat that patient, even if we think nothing is wrong, as if that person is actually having a medical emergency. Why? Because they are going to probably be the one in the courtroom with you in a lawsuit if something actually was wrong, and your failure to treat caused harm to the patient.

In Ft Worth, TX, they have a program in which when a known system abusers get visited by CCEMT-P's in mobile units to check on them to make sure they are alright. Rhyme and reason is because system abusers most of the time just want attention. This actually has reduced the number of calls to these people who abuse the system. If the patient is not doing good, patient care is initiated on the spot, and a MICU is called to respond / transport.

[paraloco]

I've never seen anything remotely like this list. I have seen posted at the station a Heads-Up type notice about a patient in our area that was on a Flo-Lan drip, and what to do if we responded to that person. I've also seen face sheets for frequent flyers in the desk, for when they don't have their ID or insurance cards. This is probably some kind of violation.

[Dustdevil]

In Ft Worth, TX, they have a program in which when a known system abusers get visited by CCEMT-P's in mobile units to check on them to make sure they are alright. Rhyme and reason is because system abusers most of the time just want attention. This actually has reduced the number of calls to these people who abuse the system. If the patient is not doing good, patient care is initiated on the spot, and a MICU is called to respond / transport.

Are these scheduled visits, random visits, or visits in lieu of an ambulance when the abuser calls 911?