Printing a bill out on completion of run

[Just Plain Ruff]

Does anyone print out a bill to patients on completion of the call?

I was wondering if this was done anywhere in the United States?

What is the Cities stance on this type of practice.

I mean the EMS agency has provided a service and the bill would be for services rendered.

It could come with a disclaimer that this was the patient would owe if they didn't have insurance. That the amount owed would be different once insurance paid.

My physician gives me a bill when I set up my follow up appointment and then sends me a bill like this all the time, showing me what I will owe if insurance fails to pay any of the amount so why cannot ambulance services do this?

Is it unethical? Is it wrong?

What are the thoughts of the City denizens?

[Arctickat]

You mean immediately after the call? While the patient is laying in the ED? My thinking is that it's a bit different when the patient is being treated by the trauma team for multiple injuries as compared to going to see my doctor for something relatively minor. Our patients get the bill in the mail a week or so later.

[Stjarna]

If they are seriously ill or injured they shouldn't have a bill given to them and shoved in their face. That's a pretty rude thing to do and would make the patient think you care more about the money than their health and well-being. I agree with Arctickat on billing being a better method.

[emtdennis]

Pretty Cold!!!!!

You have their address on the PCR, send it to them later.

At the time you pick them up, there are other more pressing things on their minds. When you get a bill from your physician, you are usually in a more calm state of mind.

[Just Plain Ruff]

ok, maybe not the ones who are having CPR or being treated for a MI OR stroke, but the ones who are let's say being transported for less life threatening illnesses.

I'm not sure where to draw the line. This is something that not just I have thought of in the past but a group of providers discussed in the past from a luncheon that I attended in the past year. It was a group of providers from Fire medics all the way up to flight providers to physicians.

We were actually just looking at ways to help patients know what their bill would be since we have all been asked "how much is this going to cost me". And if you have never been asked that question, you will be.

Maybe the wording "Bill" was wrong, maybe a summary of charges would be different.

I'm not advocating giving this to the dying grandma or the guy having the heart attack, it should be up to the medic's discretion on when to give this to the patient or their family member. I'm not that callous or heartless but seriously, I don't see the harm nor the cold heartedness to give a summary of charges to the guy who broke his ankle a summary of charges or a "bill". I don't see the harm to give the minor MVA patient this piece of paper or the patient who didn't have a ride to the hospital this summary of charges.

I'm just throwing this out there to the community here as to is it completely wrong to inform the patient that their ambulance charges are this amount and they should begin to think about the cost of the transport?

Maybe it's completely wrong to give this info to patients but I tend to think it isn't.

For those who say that this is unethical - please explain why this is unethical.

I'm willing to take some hits on this here but please do not make this a personal thing.

Edited May 23, 2012 by Captain ToHellWithItAll

[Stjarna]

A summary should be alright if they request one. Same goes for if they request the bill. However, regardless of whether it be a code or a splinter, it's still disrespectful to give the bill to them automatically unless they request such as it could be taken in the sense you work for the money rather than the people.

[Just Plain Ruff]

Why is it disrespectful? And in a sense we do work for the money and the people but I do understand that patients are fickle people. They get pissed when they are asked for insurance cards and all that.

I know that I'm going to get beat over the head on this one, and I'm ready for it so here goes.

In all other industries out there we tend to get a service and have to pay for it immediately. I know of very very few other industries that we get the service initially for free (yes ems is free initially) and then we get either the bill or insurance pays the bill minus a copay from your insurance.

So if you take your car into the shop, you get your car fixed and you pay for it immediately. If you don't pay, you don't get your car back.

If you get a new roof, you pay some up front, then pay the rest at completion and if you don't pay the roofers usually don't haul away the trash and the big truck with the wasted roofing material until you pay

So you go and purchase something you don't get the item until you pay for it.

All I'm saying is that you don't expect payment now and you tell the patient that up front when you hand them the summary of charges. Let's call it that. Let's take the word Bill out of this whole discussion because that's what people have seem to have latched onto and are against. All I'm advocating is that you provide the patient with the means to understand what the bill will be if insurance does not pay their bill from the EMS servic. Be that a bill or a summary of charges. Why is that unethical? Why is that wrong?

I am NOT advocating anywhere in this thread that you even consider to give them a summary of charges until the call is completed and the patient is on the hospital bed and your run report is complete. It is medics discretion to give the summary of charges or the bill. IF the medic decides never to give the summary of charges to any patient then by all means that is the medics prerogative. No discipline on the medic. Maybe let the medic offer the patient this "We have the ability to offer you a summary of charges sir. I can print them out if you wish. If not you will recieve the same in 2 weeks. Which would you like?" something like that.

I am also not advocating that the medic print off this summary on any patient that is critical or suffering a major medical condition such as CVA, MI, Major trauma or other comparable condition.

[Stjarna]

You make a good point, but we're dealing with people's health and lives here, not their car or a roof. Yes the money is an important aspect, but all patients are living beings that are someone's family and friends. I would like my family, friends, and myself to recieve care and respect from the Techs even as they leave. Whenever my patients are transferred over and in the bed I still take the few seconds to hold their hand for a moment and wish them well rather than rush out and wave "I'm outta' here!". Just a bit of a human and consoling gesture that will make them feel better. I believe kindness and compassion come first in any service, job, or company no matter what it may be, but that's just my belief. Introducing money into it and leaving just rubs off as a rude thing imo. Especially if it's one of those patients who does their best to find something to complain about and critique.

[island emt]

I think the big issue here is that it's not been done that way as a normal practice in the past.

I have had folks ask me how much the ambulance service will cost them. I tell them that I honestly don't know as the billing department handles this and works with the insurance company to get as much covered as possible.

That said: I am a carpenter in my real life outside EMS. When I am asked to do a job, I always give an estimate prior to ordering materials and explain that unless unforseen issues come up that can't be seen , such as hidden rotted sills or things discovered after starting the job, then the estimate is the maximum I will charge for the job. I try to envision all things and 95 % of the time my final invoice comes in lower or at the estimated price.

When the job is complete and the customer is satisfied with the work, I hand them an invoice, & expect to be paid within a reasonable amount of time. Say 7 days or less.

Had a regular customer held up paying a 2 grand bill this winter for 4 weeks. The next time I write them an invoice,[ this week] it will include an additional cost for me financing their bill last time.

It would seem to me that EMS is a service just like any other and Pt's may want to know what it cost for these services.

However many abuse the system and have no intention of paying for it anyway so they might just laugh at us giving them an invoice.

A follow up question would be: What is your services collection rate on billable's? Are you actually collecting more than 60% or 70% of what you send out?

Edited May 23, 2012 by island emt

[Bieber]

My question is... what for? I mean, what's the point in giving them the bill at time of care? Is it to scare bullshitters off or to try and increase collections or what?

Edited May 23, 2012 by Bieber