Wednesday, June 18, 2008

Volunteers raise alarm over fees

Leggett proposes ambulance charge to help pay for fire and rescue services; Duncan aired similar plan 5 years ago

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Brian Lewis⁄The Gazette
County Executive Isiah Leggett has proposed charging an ambulance fee that volunteers say is ‘‘blood money.”
Montgomery County could become the next jurisdiction to charge for ambulance rides to a hospital if the County Council approves a fee schedule ranging from $300 to $800.

But before a vote on the fee, opponents — including the county’s volunteer firefighters — are vowing to make their case that an ambulance ride should remain a free service.

If approved, the measure would take effect Jan. 1, 2009, and apply to ambulance transports for services ranging from basic non-life threatening injuries to advanced life support and specialty life support cases. In addition to the basic transport fee, the county would also charge $7.50 per mile for the trip, with an average trip being 5 miles.

The fee is expected to generate $14 million in the first year of implementation, and up to $16.2 million by the fourth year, according to a revenue report prepared for the county by an emergency management system industry law firm.

As part of the program, insurance companies — which many times already allocate money for ambulance trips — would be billed directly for the transport costs, county officials have said. Patients without insurance would receive a hardship waiver and would not be billed.

The county now does not charge insurance companies or patients for ambulance rides. With other jurisdictions taking advantage of the money already by insurance companies, County Executive Isiah Leggett has said the county is ‘‘leaving money on the table” by not implementing the fee.

Leggett (D) proposed the fee as a funding source for fire and rescue service needs, and wanted the fee included in the fiscal 2009 budget, which begins July 1. The County Council chose not to act on the fee during budget deliberations, deciding instead to revisit the proposal after the budget was passed in May.

Other jurisdictions — including Prince George’s County, Washington and Baltimore city — charge ambulance fees. Five years ago, County Executive Douglas M. Duncan (D) floated the idea of charging an ambulance fee as part of a plan to close the county’s budget gap. The council rejected the plan.

This time, the plan is different, Leggett spokesman Patrick Lacefield said.

This time people will not receive a bill, he said, also more jurisdictions have instituted a fee. Also, current demands on the county’s finances make the fees more of a necessity, Lacefield said.

‘‘The county has grown so fast we haven’t been able to keep up, especially in the Upcounty areas where we’re building four new stations,” Fire Chief Thomas W. Carr Jr. said.

The county transported about 55,000 people in 2007, Assistant Chief Scott Graham said.

Still, some within the county have worried that residents would hesitate to call for ambulance services if a fee was imposed although jurisdictions contacted by The Gazette said they have not noticed a drop in service calls.

‘‘We think ambulance fees should already be covered by taxes,” said Marcine Goodloe, president of the Montgomery County Volunteer Fire and Rescue Association. ‘‘They say insurance will cover the fees, but insurance has caps and requirements, and seniors are already struggling with Medicare caps. And insurance can choose to reject [paying the fees]. We call it ‘blood money’ that the county is trying to get.”

Former county firefighter John Barr, a Gaithersburg resident, said he is concerned about the possibility of increasing insurance fees.

‘‘One way or the other you’re going to pay, and I think this will make things worse,” said Barr, a Medicare client.

As part of the county’s plan, county residents would not be required to pay any remaining funds that an insurance company does not pay, Lacefield and others said.

For ambulance trips made outside the county, insurance companies would also be billed first. Once the company has paid its part, out-of-county residents would then receive a bill for the outstanding fee, Graham said.

‘‘Depending on what the county decides to adopt, a 30-, 60- or 90-day payment schedule, and at some point in the process we can opt to write that that off, but we are not concrete on how and when we’re going to do that,” he said.

In May, the county ran 346 EMS calls to out-of-county areas. On average, 60 percent of patients in these cases are transported, Graham said.

The average revenue per transport for a county-imposed fee is expected to range from $247 to $253 in the four-year period. The majority of ambulance fee revenue is expected to come from Medicare, the federally funded health care plan for the elderly. The report prepared by the law firm assumed an annual rate increase of 5 percent in the county’s rate schedule in years two through four.

The study estimates that on average, commercial insurers will pay about 67 percent of the EMS charges.

The report also says the difference in the county’s fees and what insurance providers will pay is ordinarily not collectable. In fact, collection of the difference is considered ‘‘balance billing” and is not allowed under Medicare law.

Ambulance fees paid by the federal government for Medicaid patients — usually provided to young and poor residents — are paid at a $100 flat rate, with nothing extra paid for mileage.

CareFirst BlueCross Blue Shield, which has more than 3.2 million clients in the Washington region, employs a fee schedule to pay for the charges. Aetna also uses a fee schedule, and provides extra money for trips longer than 50 miles and in some rural areas.

Within the county, EMS calls continue to increase, she said.

Before the fee is approved, county fire officials and administrators are hosting a series of information sessions throughout the county to answer questions about the new policy.

Already Montgomery County Councilman Philip M. Andrews — who heads the council’s Public Safety Committee — opposes the plan, as he did when Duncan proposed it.

Like Goodloe, Andrews (D-Dist. 3) of Gaithersburg said money should not be collected.

Councilman George L. Leventhal, who heads the Health and Human Services Department, would like more information.

‘‘I’m not yet satisfied about the proposal to exempt people without insurance,” said Leventhal (D-At large) of Takoma Park. ‘‘I want to know how this would work with insurance companies. The plan sounds simple, but my experience with health insurance is that things are not simple.”

To learn more

County fire officials will hold meetings at area senior centers to explain the fee. The upcoming meetings are:

10 a.m. June 24 at Holiday Park Senior Center, 3950 Ferrara Drive, Wheaton

1 p.m. June 26 at Margaret Schweinhaut Senior Center, 1000 Forest Glen Road, Silver Spring

Noon June 27 at Long Branch Senior Center, 8700 Piney Branch Road, Silver Spring

The council’s Public Safety Committee is scheduled to discuss the fee proposal June 26. A public hearing on the proposal will be held July 8.

For more information call 240-777-6530.