Printing a bill out on completion of run

[Kiwiology]

The "part charge" here has recently increased to either $65 or $80 (depending on where you live) for medical emergencies but there is no part charge for accidents because ACC (universal accident insurance) pays the Ambulance Service for that. From April next year the part charge is going to increase again to a national fee of $88 regardless of where you live. If you are from outside NZ you get a "full charge" which is $757

It was never really published that there was a charge and many people did not know which resulted in a bit of negative flack so now it's very obvious with it clearly spread all over the website and a brochure in the Ambulance. It's not directly told to people i.e. "Hello we're the Paramedics by the way your ass will be getting a bill!" but if the patient asks they are told obviously.

The part charge applies to all patients who are assessed, treated and/or transported; if you are assessed because you were the back seat passenger in a road traffic accident who only had a quick set of obs taken you get a bill, if you have a cardiac arrest and resuscitation is terminated, you get a bill etc

There have been ongoing discussions between the Ambulance Service and the Government for probably a decade now about removing the part charges provided funding from Central Government is increased to make up for it; the Ambulance Service has admitted they do not want to part charge people and believe the service should be free like Fire and Police, they've also said there is a high cost to administer the part charge system because of the administration requirements and to administer some debt recovery. Over 30% of the part charges are not paid and written off rather than recovered through a debt collector because of the negative impact that debt recovery has on the future ability of fundraising. The part charge may also prohibit some genuine Ambulance need from being met.

A bill is generated from the data captured on the patient report form and sent in the mail, with the introduction of the electronic PRF there may be a link between the PRF and the billing system so removing at least a component of the manual administration requirement and reducing cost.

[paramedicmike]

IslandEMT and Bieber both had the same thought I had. While I understand where the OP was going I'm not entirely sure the results of this practice are going to do any good.

People who don't care, such as chronic abusers of the system including frequent fliers and the like, won't care. They don't plan to pay anyway so it's not going to matter to them what or how much the charges are.

The people who are conscientious about their bills in general will, if appropriately delivered, probably appreciate the information especially if they know insurance is going to pick up the tab. However, these aren't people from whom we need to worry about collecting.

A concern should be the older folks who were afraid to call 911 because they were afraid of the cost regardless of their insurance status. We've all seen these people. They're the ones who usually need EMS but were afraid to call because they either didn't want to bother us or will tell us they were afraid of the bill they'd get afterwards. If we were to hand them an itemized statement of cost shortly after arrival at the ED it would just feed into the fears and there's a chance it could work negatively in the future as it might scare them off from calling 911 again.

Even though people don't pay for services at the time they're rendered doesn't mean EMS is free. They will still get the bill and, with any luck, we'll be able to collect on at least some of it. By placing such an immediate emphasis on cost at the time of service has the potential to paint the industry as little more than greedy bastards who aren't truly interested in helping as much as we are in making a buck. It also raises the question if we should be telling people if their reason for calling 911 was worthy enough (the potential for which increases if we hand them an itemized summary on the spot). That's an awful slipperly slope and the topic has lead to some very interesting discussions here in the past.

[Just Plain Ruff]

no, this is not to scare the abusers off. That's not the point of this.

It was simply a discussion between a group of about 15 providers like I said. We were sitting around the table after a full meal discussing how to make patients more aware of what the service will cost them when they get their bill after insurance pays their share, or if insurance doesn't pay or if they don't have insurance.

This is not to say F you to the patient, don't get me wrong, this was a heartfelt discussion to help the patient understand that there would be a charge because in this economy we were seeing a huge trend of patients asking us this question. how much is this going to cost me and we were not able to tell them or we were only able to say "I don't know, you will have to call our billing office". WE were kicking around the prospect of how could we give the patients who asked or give all patients, barring severity of conditions, a informational piece of paper that would give them some understanding of what they would be paying for their ambulance bill.

At no time was there a discussion or mention of giving them the info prior to transport.

We did not come up with any consensus so this is why I brought it to the smartest group of people I know.

There is no malice towards any patient demographic in the intention of this thread.

[paramedicmike]

I get what you're saying, Mike. What's the difference, then, between including the itemization of charges on the bill that is sent versus handing it to them upon arrival? If it's included in the bill itself, which should be received several days later, then they'll probably be in a better frame of mind to comprehend the information as opposed to being stressed about being sick, transported by ambulance and being in the ER.

[Just Plain Ruff]

IslandEMT and Bieber both had the same thought I had. While I understand where the OP was going I'm not entirely sure the results of this practice are going to do any good.

People who don't care, such as chronic abusers of the system including frequent fliers and the like, won't care. They don't plan to pay anyway so it's not going to matter to them what or how much the charges are.

The people who are conscientious about their bills in general will, if appropriately delivered, probably appreciate the information especially if they know insurance is going to pick up the tab. However, these aren't people from whom we need to worry about collecting.

A concern should be the older folks who were afraid to call 911 because they were afraid of the cost regardless of their insurance status. We've all seen these people. They're the ones who usually need EMS but were afraid to call because they either didn't want to bother us or will tell us they were afraid of the bill they'd get afterwards. If we were to hand them an itemized statement of cost shortly after arrival at the ED it would just feed into the fears and there's a chance it could work negatively in the future as it might scare them off from calling 911 again.

Even though people don't pay for services at the time they're rendered doesn't mean EMS is free. They will still get the bill and, with any luck, we'll be able to collect on at least some of it. By placing such an immediate emphasis on cost at the time of service has the potential to paint the industry as little more than greedy bastards who aren't truly interested in helping as much as we are in making a buck. It also raises the question if we should be telling people if their reason for calling 911 was worthy enough (the potential for which increases if we hand them an itemized summary on the spot). That's an awful slipperly slope and the topic has lead to some very interesting discussions here in the past.

And Mike Excellent point. That's why the discussion we had lasted for several hours with no real answers to come from it.

Some were totally for giving every single patient a bill, including the family members of those in arrest.

Others were totally against it.

WE never came to any conclusion as to what was acceptable or not.

What a couple of those at the table came up with, myself included was to offer those patients this. We would tell the patient that asked us at the beginning of the call what this would cost, we would tell them at the end of the call that we could provide them with a list of approximate charges. The "summary of charges" and print it out. We would offer it and if they accepted then we would print it out and give it to them. But of course this would have to be offered by each service not just one service. But that was the only option we could come up with that was mutually agreeable.

LIke I said, we spent several hours sitting around batting this around and never came to consensus which I'm sure this will end up the way that our discussion did but I'm still interested in what others think as well.

I get what you're saying, Mike. What's the difference, then, between including the itemization of charges on the bill that is sent versus handing it to them upon arrival? If it's included in the bill itself, which should be received several days later, then they'll probably be in a better frame of mind to comprehend the information as opposed to being stressed about being sick, transported by ambulance and being in the ER.

But the bills aren't usually received several days later, they usually go through insurance and then to the patient. My wife was transported by Belton ambulance twice, WE didn't receive an ambulance bill for at least a month. And it was not itemized, it was a single number. We had to call and request an itemized bill. That took another 3 weeks. So it's not as fast at some services as others.

[paramedicmike]

Well, that's what I'm asking. What's the difference between handing it directly to them versus including it with, say, an itemized summary of what has been submitted to insurance?

My dentist does this. I'll pay my copay at the time of the appointment. Then, at some point in the future, I'll get an itemized list of services adding up the total cost. There are line items indicating services provided, charges for services and what has been submitted to the insurance company for payment. There's also a line advising me that I'm on the hook for whatever insurance doesn't cover.

[Bieber]

Mike, those people who were in favor of this, what were their reasons behind it? Like, what was the goal of it supposed to be?

[Just Plain Ruff]

Bieber, I think it was awareness for the patients who asked what the bill was going to be.

The initial discussion question went like this. "Does anyone have the capability to print out a bill for the patient on the spot so the patient can pay it?" I belive that was the initial question by a paramedic.

Maybe that should have been the inital question I asked.

Does anyone have the ability to print out a bill for a patient who wishes to pay the ambulance bill at the culmination of the transport?

[paramedicmike]

That's an interesting question. None of the services at which I've worked in the last 10 years have had the ability to print anything out at any hospital to which we've transported. All charting and printing was done back at that station.

[Arctickat]

How about a lighted sign in the back of the ambulance that scrolls the current charges across the screen, kinda like a taxi meter. Put a UPC code scanner by the patient's head and every time you use an item it'll increase the total on the screen. If you charge a mileage rate, have it add up every mile. Then, as the patient is rolled out at the hospital he can look at the screen on the way out to see the final tally. Set it up right and you can even have him swipe his credit card on the way out. [/smartass comment]