Ethical, illegal or greedy?

[Guest guest]

Company X goes on a public assist call because granny has fallen and can't get

up. The crew for company X arrives and gets granny up out of the floor. She

does not want to be transported to the ER. Crew gets her information and signed

AMA. Company X then charges granny $75 as a no transport charge. Is this

legal? Is the company just greedy for money? Does the pt for her insurance

company pay?

How about one that you AMA from a fight because they did not call for EMS and

don't want to be billed for services they did not request? However, they get

billed the same amount as granny did for AMA. Pt refuses to provide info, so

crew calls the local hospital for billing info. Does this violate HIPPA since

the pt was never seen in the ER this trip?

There are providers out there that do this. What is everyones view on this.

Wayne

---------------------------------

Need a vacation? Get great deals to amazing places on Yahoo! Travel.

[Guest guest]

Re: Ethical, illegal or greedy?

It's up to the company whether or not it wishes to charge for this service.

Many services do not, for reasons of good public relations; however, some do.

If Granny called EMS, they can bill her. If somebody else called for her

at her behest, she can still be billed. If a medical alert service called

you, she can be billed. If she didn't call and doesn't know who did, if she

accepts the service, she can be billed, but the service should explain to her

that she will be billed in any case. I suppose she could elect to stay in the

floor, but in practice that's not going to happen. If it were my service, I

wouldn't bill for it, but there are those that would.

Some cities bill for garbage service whether you use it or not. So on that

basis, I suppose the City of Dog Patch EMS, being a municipal service could

bill for every response if they passed the proper ordinances. They could also

bill for fire service and probably police services, although I'm not sure

about that and I don't intend to spend time researching it.

In the second instance, the patient is probably on good grounds not to pay

the bill unless, as stated above, the city has a policy of billing for all

responses, and even then, I think it's legally doubtful that the charge would

stick. If Pizza Hut delivers a Giant Supreme to my house and I didn't order

it, I

don't have to accept it or pay for it. EMS service is basically the same,

although not as tasty.

HIPAA would not be violated by securing patient information from the

hospital, since one of the three exceptions to HIPAA that allow use of

information and

freeflow of information is for billing purposes. However, I wouldn't be

surprised at all if the hospital refused to provide the information.

But let's say that this guy is a frequent flyer. Certainly the service

could retrieve his records and get his address from them. The prospect of his

paying in any event is nil, so why bother? It will cost more to bill him than

the service will ever get.

Is all of this pretty sleazy? Yep, in my judgment, but sleaze and legal are

not the same, some folks' opinions to the contrary.

Gene

>

> Company X goes on a public assist call because granny has fallen and can't

> get up. The crew for company X arrives and gets granny up out of the floor.

> She does not want to be transported to the ER. Crew gets her information and

> signed AMA. Company X then charges granny $75 as a no transport charge. Is

this

> legal? Is the company just greedy for money? Does the pt for her insurance

> company pay?

>

> How about one that you AMA from a fight because they did not call for EMS

> and don't want to be billed for services they did not request? However, they

> get billed the same amount as granny did for AMA. Pt refuses to provide

info,

> so crew calls the local hospital for billing info. Does this violate HIPPA

> since the pt was never seen in the ER this trip?

>

> There are providers out there that do this. What is everyones view on this.

>

> Wayne

>

> ------------ -------- -------- --

> Need a vacation? Get great deals to amazing places on Yahoo! Travel.

>

>

[Guest guest]

Gene and Wayne,

We consider ourselves a reputable service and we charge a service refusal

charge. Our Charge is 50.00. We only charge this fee if your or a member of your

family request that we respond to your residence. It is only reasonable to

expect that if you call or your family calls that we should be able to charge

for our services. That service being a response, an assessment and our opinion

of your need for further care or transport. The guy that comes out to check out

your freezer that isn't cooling and finds that you have many packages of trout

blocking the vent is all that is wrong, still charges you a fee.

We on occasion (we bill all inclusive) will start an I.V. and deliver glucose to

a patient only to have his\her blood sugar return to normal with a return to

normal orientation accompanied with a statement of I am not going to the

hospital. These patients we charge a refusal fee of 50.00.

Hey what about that frequent flyer who falls every day and just needs help

getting up off the floor. We arrive and the family stands around while we put

them back in their chair or bed.

What about that frequent flyer that calls just because he is not feeling well

and just wants to be checked out.

Well we bills those a refusal charge also. If they are responsible and they feel

the need to pay their bills they will figure out that maybe they don't need to

call unless their is a reasonable expectation that they want to go to the

hospital.

A large portion of the accounts we send to collections are indeed the refusal

fees. Does that bother me, not in the least so long as it meets the above

criteria listed in the first paragraph. We are a county run service and simply

cannot give our services away, at the same time we feel all our charges are

reasonable and lower than most if not all other providers around us.

Henry

Re: Ethical, illegal or greedy?

It's up to the company whether or not it wishes to charge for this service.

Many services do not, for reasons of good public relations; however, some do.

If Granny called EMS, they can bill her. If somebody else called for her

at her behest, she can still be billed. If a medical alert service called

you, she can be billed. If she didn't call and doesn't know who did, if she

accepts the service, she can be billed, but the service should explain to her

that she will be billed in any case. I suppose she could elect to stay in the

floor, but in practice that's not going to happen. If it were my service, I

wouldn't bill for it, but there are those that would.

Some cities bill for garbage service whether you use it or not. So on that

basis, I suppose the City of Dog Patch EMS, being a municipal service could

bill for every response if they passed the proper ordinances. They could also

bill for fire service and probably police services, although I'm not sure

about that and I don't intend to spend time researching it.

In the second instance, the patient is probably on good grounds not to pay

the bill unless, as stated above, the city has a policy of billing for all

responses, and even then, I think it's legally doubtful that the charge would

stick. If Pizza Hut delivers a Giant Supreme to my house and I didn't order

it, I

don't have to accept it or pay for it. EMS service is basically the same,

although not as tasty.

HIPAA would not be violated by securing patient information from the

hospital, since one of the three exceptions to HIPAA that allow use of

information and

freeflow of information is for billing purposes. However, I wouldn't be

surprised at all if the hospital refused to provide the information.

But let's say that this guy is a frequent flyer. Certainly the service

could retrieve his records and get his address from them. The prospect of his

paying in any event is nil, so why bother? It will cost more to bill him than

the service will ever get.

Is all of this pretty sleazy? Yep, in my judgment, but sleaze and legal are

not the same, some folks' opinions to the contrary.

Gene

>

> Company X goes on a public assist call because granny has fallen and can't

> get up. The crew for company X arrives and gets granny up out of the floor.

> She does not want to be transported to the ER. Crew gets her information and

> signed AMA. Company X then charges granny $75 as a no transport charge. Is

this

> legal? Is the company just greedy for money? Does the pt for her insurance

> company pay?

>

> How about one that you AMA from a fight because they did not call for EMS

> and don't want to be billed for services they did not request? However, they

> get billed the same amount as granny did for AMA. Pt refuses to provide

info,

> so crew calls the local hospital for billing info. Does this violate HIPPA

> since the pt was never seen in the ER this trip?

>

> There are providers out there that do this. What is everyones view on this.

>

> Wayne

>

> ------------ -------- -------- --

> Need a vacation? Get great deals to amazing places on Yahoo! Travel.

>

>

[Guest guest]

Thanks for the replys. This was just something that was brought up yesterday

during an EMS discussion and talk about EMS fraud.

Wayne

Wayne D wrote:

Company X goes on a public assist call because granny has fallen and

can't get up. The crew for company X arrives and gets granny up out of the

floor. She does not want to be transported to the ER. Crew gets her information

and signed AMA. Company X then charges granny $75 as a no transport charge. Is

this legal? Is the company just greedy for money? Does the pt for her insurance

company pay?

How about one that you AMA from a fight because they did not call for EMS and

don't want to be billed for services they did not request? However, they get

billed the same amount as granny did for AMA. Pt refuses to provide info, so

crew calls the local hospital for billing info. Does this violate HIPPA since

the pt was never seen in the ER this trip?

There are providers out there that do this. What is everyones view on this.

Wayne

---------------------------------

Need a vacation? Get great deals to amazing places on Yahoo! Travel.

[Guest guest]

A number of years ago (been a while) a smaller service in the eastern Texas area

(fortunately long ago shut down), was well known for charging as much as $500.00

for no-rides and in one case (as the story was told) they sent on of their

" no-ride " bills to an elderly lady who had just lost her husband who was coded

on their living room floor. This occurred after the local police department had

to respond to an area river to alert them to the call - it seems they were

fishing and were away from their radio.

I think unethical and greedy fit that case.

Don

>>> " Wayne D " 07/24/07 8:53 AM >>>

Thanks for the replys. This was just something that was brought up yesterday

during an EMS discussion and talk about EMS fraud.

Wayne

Wayne D wrote:

Company X goes on a public assist call because granny has fallen and

can't get up. The crew for company X arrives and gets granny up out of the

floor. She does not want to be transported to the ER. Crew gets her information

and signed AMA. Company X then charges granny $75 as a no transport charge. Is

this legal? Is the company just greedy for money? Does the pt for her insurance

company pay?

How about one that you AMA from a fight because they did not call for EMS and

don't want to be billed for services they did not request? However, they get

billed the same amount as granny did for AMA. Pt refuses to provide info, so

crew calls the local hospital for billing info. Does this violate HIPPA since

the pt was never seen in the ER this trip?

There are providers out there that do this. What is everyones view on this.

Wayne

---------------------------------

Need a vacation? Get great deals to amazing places on Yahoo! Travel.

[Guest guest]

Wayne,

Like some of the others who have already replied, we do charge for no transports

if the call was placed by the patient or someone who could reasonably be

expected to act on behalf of the patient (family member, caretaker, nursing

home, alarm company, etc). If the call was not placed by the patient or someone

acting on behalf of the patient but the patient still accepts care, we charge.

We do have specific guidelines that we follow and our personnel are real good

about getting the proper information regarding how the call was originally

received and who placed the call so we can apply the guidelines in a fair and

consistant manner. We charge a base fee plus supplies, etc. We don't hear any

more complaints about the no transport charges than we do about the transport

charges.

What I have not seen any comments on, yet, is this. Our collection rate on no

transport calls is about 20% of the total billed. Also, (and this is what

surprised me when I started tracking the no transport charges) of the total

dollars paid a little over half of it is paid by insurance, not by the patient.

The 20% may seem low, but for a large department with a high run volume the

total collected can be high. For a small department with limited resources, any

amount collected can be important.

Consider it from this perspective. The amount that our small department

collected on no tranport calls last year was more than enough to cover the cost

of adding CPAP to our ambulances. So, even though the dollar amount may have

been relatively small, what could be done with those dollars was very

significant.

Maxine Pate

hire-Pattison EMS

---- Original message ----

>Date: Mon, 23 Jul 2007 20:29:31 -0700 (PDT)

>

>Subject: Ethical, illegal or greedy?

>To: Texas EMS list <texasems-l >

>

> Company X goes on a public assist call because

> granny has fallen and can't get up. The crew for

> company X arrives and gets granny up out of the

> floor. She does not want to be transported to the

> ER. Crew gets her information and signed AMA.

> Company X then charges granny $75 as a no transport

> charge. Is this legal? Is the company just greedy

> for money? Does the pt for her insurance company

> pay?

>

> How about one that you AMA from a fight because they

> did not call for EMS and don't want to be billed for

> services they did not request? However, they get

> billed the same amount as granny did for AMA. Pt

> refuses to provide info, so crew calls the local

> hospital for billing info. Does this violate HIPPA

> since the pt was never seen in the ER this trip?

>

> There are providers out there that do this. What is

> everyones view on this.

>

> Wayne

>

> ---------------------------------

> Need a vacation? Get great deals to amazing places

> on Yahoo! Travel.

>

> [Non-text portions of this message have been

> removed]

>

>

[Guest guest]

This discussion greatly bothers me. Why should EMS, like all other facets of

healthcare, not be able to charge to cover their expenses? I like Henry's

statement about the freezer repair man...what a great analogy. Despite the

fact that no one pays for it out of pocket (in most cases) it costs dollars each

and every time the " rig " is pulled out of the barn. Diesel is almost $3 a

gallon, wear and tear adds up, the cost of people (except volunteers...real

ones...those that don't get paid not the ones that do but still call themselves

volunteers), supplies, risk, workers compensation, trash removal, uniforms,

printing of documents, payroll costs, recruitment costs, CE costs, etc.Â

One of the primary issues we will have in survival of EMS is the fact that we

have TRADITIONALLY had our services tied to transporting people. As we go

forward, scope of practice expands, and we are taking less and less to the

hospital in favor of other options...(read the EMS Agenda for the Future)...if

our only " non-greedy " form of payment is tied to turning wheels we will die...

We charge an " aid call " fee for those patients who we respond to and treat. It

is $125. We also charge an Air Med Assist fee for those patients who get flown

out (about 18 of 6,200 requests annually) of $250 because it makes no sense for

us to extricate, strap to a board, start 2 IV's, intubate, pharmacologically

assist, etc, etc and send them off in a helicopter...and not charge...the air

med service isn't discounting their bill for the work we did. In addition, if

we put the patient in the ambulance and transport them to the LZ, we charge them

a standard transport fee plus mileage...even if it is 50 yards to the LZ. Our

average transport fee is a shade under $1,000 on average. This keeps our " per

capita " government subsidy to a shade over $10 per citizen.Â

Really folks, we have to get past the fact that us getting paid for the services

we provide is somehow wrong or immoral. The volunteer, all here for the

community, concept was great as we started....but we have to move past it.Â

Times have changed and if we continue to stand in this tar pit of " we can't

charge, that's wrong " we will soon become extinct like other dinosaurs of the

past.

Think about this...on the hospital administrator list serve or the physician

list serve...how many discussions do you suppose they have regarding how immoral

or unethical it is to charge an extra $1.25 a cup of coffee in the starbucks in

the lobby so that the hospital gets its take? Or is it okay to charge for the

aspirin given to the chest pain patient that left AMA? Well I never...

Dudley

Re: Ethical, illegal or greedy?

A number of years ago (been a while) a smaller service in the eastern Texas area

(fortunately long ago shut down), was well known for charging as much as $500.00

for no-rides and in one case (as the story was told) they sent on of their

" no-ride " bills to an elderly lady who had just lost her husband who was coded

on their living room floor. This occurred after the local police department had

to respond to an area river to alert them to the call - it seems they were

fishing and were away from their radio.

I think unethical and greedy fit that case.

Don

>>> " Wayne D " 07/24/07 8:53 AM >>>

Thanks for the replys. This was just something that was brought up yesterday

during an EMS discussion and talk about EMS fraud.

Wayne

Wayne D wrote:

Company X goes on a public assist call because granny has fallen and can't get

up. The crew for company X arrives and gets granny up out of the floor. She does

not want to be transported to the ER. Crew gets her information and signed AMA.

Company X then charges granny $75 as a no transport charge. Is this legal? Is

the company just greedy for money? Does the pt for her insurance company pay?

How about one that you AMA from a fight because they did not call for EMS and

don't want to be billed for services they did not request? However, they get

billed the same amount as granny did for AMA. Pt refuses to provide info, so

crew calls the local hospital for billing info. Does this violate HIPPA since

the pt was never seen in the ER this trip?

There are providers out there that do this. What is everyones view on this.

Wayne

---------------------------------

Need a vacation? Get great deals to amazing places on Yahoo! Travel.

[Guest guest]

As morally reprehensible as it may seem and as painful as it may be...I think I

have to agree with Henry and Dudley in the same posting. The future of EMS will

see us doing far more non-transported streetside clinical work, as we are the

natural extension of medicine into the street. Charging for non-transport

situations will become inevitable for most, if not all, of us.

Vernon Gresham

City of Ganado

Re: Ethical, illegal or greedy?

A number of years ago (been a while) a smaller service in the eastern Texas

area (fortunately long ago shut down), was well known for charging as much as

$500.00 for no-rides and in one case (as the story was told) they sent on of

their " no-ride " bills to an elderly lady who had just lost her husband who was

coded on their living room floor. This occurred after the local police

department had to respond to an area river to alert them to the call - it seems

they were fishing and were away from their radio.

I think unethical and greedy fit that case.

Don

>>> " Wayne D " 07/24/07 8:53 AM >>>

Thanks for the replys. This was just something that was brought up yesterday

during an EMS discussion and talk about EMS fraud.

Wayne

Wayne D wrote:

Company X goes on a public assist call because granny has fallen and can't get

up. The crew for company X arrives and gets granny up out of the floor. She does

not want to be transported to the ER. Crew gets her information and signed AMA.

Company X then charges granny $75 as a no transport charge. Is this legal? Is

the company just greedy for money? Does the pt for her insurance company pay?

How about one that you AMA from a fight because they did not call for EMS and

don't want to be billed for services they did not request? However, they get

billed the same amount as granny did for AMA. Pt refuses to provide info, so

crew calls the local hospital for billing info. Does this violate HIPPA since

the pt was never seen in the ER this trip?

There are providers out there that do this. What is everyones view on this.

Wayne

---------------------------------

Need a vacation? Get great deals to amazing places on Yahoo! Travel.

[Guest guest]

Why would it be morally reprehensible to do more non-transported

streetside clinical work?

Re: Ethical, illegal or greedy?

* As morally reprehensible as it may seem and as painful as it may

be...I think I have to agree with Henry and Dudley in the same posting.

The future of EMS will see us doing far more non-transported streetside

clinical work, as we are the natural extension of medicine into the

street. Charging for non-transport situations will become inevitable for

most, if not all, of us.

Vernon Gresham

City of Ganado

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[Guest guest]

Are you billing this straight to the patient? Insurance?

Able to collect?

Truly curious ..

From: texasems-l [mailto:texasems-l ] On

Behalf Of THEDUDMAN@...

We also charge an Air Med Assist fee for those patients who get flown

out (about 18 of 6,200 requests annually) of $250 because it makes no

sense for us to extricate, strap to a board, start 2 IV's, intubate,

pharmacologically assist, etc, etc and send them off in a

helicopter..-.and not charge...the air med service isn't discounting

their bill for the work we did

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7/23/2007 7:45 PM

[Guest guest]

Henry,

That's entirely reasonable, and I think that's what I was trying to say. I

might not have made it clear that I felt it perfectly legitimate to bill for

service asked for.

I would not, however, bill somebody at a little MVC where a 3rd party

passerby called EMS on his cellular, you get there, and everybody refuses and

says

they didn't call.

I don't think you bill for those instances, do you? I think you COULD, if

an ordinance were enacted permitting it, but I'd have to do some " deep

thinking " about that. I know that I would refuse to pay such a bill if I were

one of

the people who clearly indicated that I was not a patient and didn't call.

However, if I ask you to check me out and help me decide whether or not to go

to the hospital, that's a request for service, and when you provide that

service it's legitimate and proper for you to bill.

If I go to Mcs, order a cup of coffee but then decide not to drink it,

I still have to pay for it. No argument there at all.

But yes, the guy who calls every time he wants a light bulb changed certainly

should be carged for the call.

GG

>

> Gene and Wayne,

>

> We consider ourselves a reputable service and we charge a service refusal

> charge. Our Charge is 50.00. We only charge this fee if your or a member of

> your family request that we respond to your residence. It is only reasonable

to

> expect that if you call or your family calls that we should be able to charge

> for our services. That service being a response, an assessment and our

> opinion of your need for further care or transport. The guy that comes out to

> check out your freezer that isn't cooling and finds that you have many

packages

> of trout blocking the vent is all that is wrong, still charges you a fee.

>

> We on occasion (we bill all inclusive) will start an I.V. and deliver

> glucose to a patient only to have his\her blood sugar return to normal with a

> return to normal orientation accompanied with a statement of I am not going to

the

> hospital. These patients we charge a refusal fee of 50.00.

>

> Hey what about that frequent flyer who falls every day and just needs help

> getting up off the floor. We arrive and the family stands around while we put

> them back in their chair or bed.

>

> What about that frequent flyer that calls just because he is not feeling

> well and just wants to be checked out.

>

> Well we bills those a refusal charge also. If they are responsible and they

> feel the need to pay their bills they will figure out that maybe they don't

> need to call unless their is a reasonable expectation that they want to go to

> the hospital.

>

> A large portion of the accounts we send to collections are indeed the

> refusal fees. Does that bother me, not in the least so long as it meets the

above

> criteria listed in the first paragraph. We are a county run service and simply

> cannot give our services away, at the same time we feel all our charges are

> reasonable and lower than most if not all other providers around us.

>

> Henry

> Re: Ethical, illegal or greedy?

>

> It's up to the company whether or not it wishes to charge for this service.

> Many services do not, for reasons of good public relations; however, some

> do.

> If Granny called EMS, they can bill her. If somebody else called for her

> at her behest, she can still be billed. If a medical alert service called

> you, she can be billed. If she didn't call and doesn't know who did, if she

> accepts the service, she can be billed, but the service should explain to

> her

> that she will be billed in any case. I suppose she could elect to stay in

> the

> floor, but in practice that's not going to happen. If it were my service, I

> wouldn't bill for it, but there are those that would.

>

> Some cities bill for garbage service whether you use it or not. So on that

> basis, I suppose the City of Dog Patch EMS, being a municipal service could

> bill for every response if they passed the proper ordinances. They could

> also

> bill for fire service and probably police services, although I'm not sure

> about that and I don't intend to spend time researching it.

>

> In the second instance, the patient is probably on good grounds not to pay

> the bill unless, as stated above, the city has a policy of billing for all

> responses, and even then, I think it's legally doubtful that the charge

> would

> stick. If Pizza Hut delivers a Giant Supreme to my house and I didn't order

> it, I

> don't have to accept it or pay for it. EMS service is basically the same,

> although not as tasty.

>

> HIPAA would not be violated by securing patient information from the

> hospital, since one of the three exceptions to HIPAA that allow use of

> information and

> freeflow of information is for billing purposes. However, I wouldn't be

> surprised at all if the hospital refused to provide the information.

>

> But let's say that this guy is a frequent flyer. Certainly the service

> could retrieve his records and get his address from them. The prospect of

> his

> paying in any event is nil, so why bother? It will cost more to bill him

> than

> the service will ever get.

>

> Is all of this pretty sleazy? Yep, in my judgment, but sleaze and legal are

> not the same, some folks' opinions to the contrary.

>

> Gene

>

>

> >

> > Company X goes on a public assist call because granny has fallen and can't

> > get up. The crew for company X arrives and gets granny up out of the

> floor.

> > She does not want to be transported to the ER. Crew gets her information

> and

> > signed AMA. Company X then charges granny $75 as a no transport charge. Is

> this

> > legal? Is the company just greedy for money? Does the pt for her insurance

> > company pay?

> >

> > How about one that you AMA from a fight because they did not call for EMS

> > and don't want to be billed for services they did not request? However,

> they

> > get billed the same amount as granny did for AMA. Pt refuses to provide

> info,

> > so crew calls the local hospital for billing info. Does this violate HIPPA

> > since the pt was never seen in the ER this trip?

> >

> > There are providers out there that do this. What is everyones view on

> this.

> >

> > Wayne

> >

> > ------------ -------- -------- --

> > Need a vacation? Get great deals to amazing places on Yahoo! Travel.

> >

> >

[Guest guest]

Dudley,

I don't have a problem with billing for services that are requested. I

thought I made that clear. But what about this:

There's a little fender bender, and a passerby calls 911 from his cell while

passing by. He's not involved and not on scene when you get there. On

arrival, all passengers are out of the cars, uninjured, all refuse service, and

all say they did not request that EMS respond. Would you bill those people?

Gene

>

>

> This discussion greatly bothers me. Why should EMS, like all other facets

> of healthcare, not be able to charge to cover their expenses? I like Henry's

> statement about the freezer repair man...what a great analogy. Despite the

> fact that no one pays for it out of pocket (in most cases) it costs dollars

> each and every time the " rig " is pulled out of the barn. Diesel is almost $3

a

> gallon, wear and tear adds up, the cost of people (except volunteers.. This

> discussion greatly bothers me. Why should EMS, like all other facets of

> healthcare, not be able to charge to cover their expenses? I like Henry's

> statement about the freezer repair man...what a great analogy. Despite the

fact

>

> One of the primary issues we will have in survival of EMS is the fact that

> we have TRADITIONALLY had our services tied to transporting people. As we go

> forward, scope of practice expands, and we are taking less and less to the

> hospital in favor of other options...(read the EMS Agenda for the Future)...if

> our only " non-greedy " form of payment is tied to turning wheels we will

> die...

>

> We charge an " aid call " fee for those patients who we respond to and treat.Â

> It is $125. We also charge an Air Med Assist fee for those patients who get

> flown out (about 18 of 6,200 requests annually) of $250 because it makes no

> sense for us to extricate, strap to a board, start 2 IV's, intubate,

> pharmacologically assist, etc, etc and send them off in a helicopter.. We

charge an

> " aid call " fee for those patients who we respond to and treat. It is $125.Â

> We also charge an Air Med Assist fee for those patients who get flown out

> (about 18 of 6,200 requests annually) of $250 because it makes no sense for us

to

> extricate, strap to a board, start 2 IV's, intubate, pharmacologically

> assist, etc, etc and send them off in a helicopter..<wbr>.and not charge...the

air

> med

>

> Really folks, we have to get past the fact that us getting paid for the

> services we provide is somehow wrong or immoral. The volunteer, all here for

the

> community, concept was great as we started....but we have to move past it.Â

> Times have changed and if we continue to stand in this tar pit of " we can't

> charge, that's wrong " we will soon become extinct like other dinosaurs of the

> past.

>

> Think about this...on the hospital administrator list serve or the physician

> list serve...how many discussions do you suppose they have regarding how

> immoral or unethical it is to charge an extra $1.25 a cup of coffee in the

> starbucks in the lobby so that the hospital gets its take? Or is it okay to

> charge for the aspirin given to the chest pain patient that left AMA? Well I

> never...

>

> Dudley

>

> Re: Ethical, illegal or greedy?

>

> A number of years ago (been a while) a smaller service in the eastern Texas

> area (fortunately long ago shut down), was well known for charging as much as

> $500.00 for no-rides and in one case (as the story was told) they sent on of

> their " no-ride " bills to an elderly lady who had just lost her husband who

> was coded on their living room floor. This occurred after the local police

> department had to respond to an area river to alert them to the call - it

seems

> they were fishing and were away from their radio.

>

> I think unethical and greedy fit that case.

>

> Don

>

> >>> " Wayne D " 07/24/07 8:53 AM >>>

> Thanks for the replys. This was just something that was brought up yesterday

> during an EMS discussion and talk about EMS fraud.

>

> Wayne

>

> Wayne D wrote:

> Company X goes on a public assist call because granny has fallen and can't

> get up. The crew for company X arrives and gets granny up out of the floor.

> She does not want to be transported to the ER. Crew gets her information and

> signed AMA. Company X then charges granny $75 as a no transport charge. Is

this

> legal? Is the company just greedy for money? Does the pt for her insurance

> company pay?

>

> How about one that you AMA from a fight because they did not call for EMS

> and don't want to be billed for services they did not request? However, they

> get billed the same amount as granny did for AMA. Pt refuses to provide info,

> so crew calls the local hospital for billing info. Does this violate HIPPA

> since the pt was never seen in the ER this trip?

>

> There are providers out there that do this. What is everyones view on this.

>

> Wayne

>

> ------------ -------- -------- --

> Need a vacation? Get great deals to amazing places on Yahoo! Travel.

>

>

[Guest guest]

You bring up a good point. Who is a patient and who is not?

I would consider the non-injured/non-calling to be non-patients, but I wanted

to get Dudley's view on it. Maybe he will chime in.

Gene

>

> If they are not injured are they patients? Two issues, a person who is a

> patient and you treat them and someone who was in an accident and is not

> injured.

>

> AJL

>

>

> >

> > Dudley,

> >

> > I don't have a problem with billing for services that are requested. I

> > thought I made that clear. But what about this:

> >

> > There's a little fender bender, and a passerby calls 911 from his cell

> > while

> > passing by. He's not involved and not on scene when you get there. On

> > arrival, all passengers are out of the cars, uninjured, all refuse

> > service, and

> > all say they did not request that EMS respond. Would you bill those

> > people?

> >

> > Gene

> > In a message dated 7/24/07 9:26:21 AM, THEDUDMAN@...<

> THEDUDMAN%40aol.THE>writes:

> >

> > >

> > >

> > > This discussion greatly bothers me. Why should EMS, like all other

> > facets

> > > of healthcare, not be able to charge to cover their expenses? I like

> > Henry's

> > > statement about the freezer repair man...what a great analogy. Despite

> > the

> > > fact that no one pays for it out of pocket (in most cases) it costs

> > dollars

> > > each and every time the " rig " is pulled out of the barn. Diesel is

> > almost $3 a

> > > gallon, wear and tear adds up, the cost of people (except volunteers..

> > This

> > > discussion greatly bothers me. Why should EMS, like all other facets of

> >

> > > healthcare, not be able to charge to cover their expenses? I like

> > Henry's

> > > statement about the freezer repair man...what a great analogy. Despite

> > the fact

> > >

> > > One of the primary issues we will have in survival of EMS is the fact

> > that

> > > we have TRADITIONALLY had our services tied to transporting people. As

> > we go

> > > forward, scope of practice expands, and we are taking less and less to

> > the

> > > hospital in favor of other options...(read the EMS Agenda for the

> > Future)...if

> > > our only " non-greedy " form of payment is tied to turning wheels we will

> > > die...

> > >

> > > We charge an " aid call " fee for those patients who we respond to and

> > treat.

> > > It is $125. We also charge an Air Med Assist fee for those patients who

> > get

> > > flown out (about 18 of 6,200 requests annually) of $250 because it makes

> > no

> > > sense for us to extricate, strap to a board, start 2 IV's, intubate,

> > > pharmacologically assist, etc, etc and send them off in a helicopter..

> > We charge an

> > > " aid call " fee for those patients who we respond to and treat. It is

> > $125.

> > > We also charge an Air Med Assist fee for those patients who get flown

> > out

> > > (about 18 of 6,200 requests annually) of $250 because it makes no sense

> > for us to

> > > extricate, strap to a board, start 2 IV's, intubate, pharmacologically

> > > assist, etc, etc and send them off in a helicopter..<wbr>.and not

> > charge...the air

> > > med

> > >

> > > Really folks, we have to get past the fact that us getting paid for the

> > > services we provide is somehow wrong or immoral. The volunteer, all

> > here for the

> > > community, concept was great as we started....but we have to move past

> > it.

> > > Times have changed and if we continue to stand in this tar pit of " we

> > can't

> > > charge, that's wrong " we will soon become extinct like other dinosaurs

> > of the

> > > past.

> > >

> > > Think about this...on the hospital administrator list serve or the

> > physician

> > > list serve...how many discussions do you suppose they have regarding how

> >

> > > immoral or unethical it is to charge an extra $1.25 a cup of coffee in

> > the

> > > starbucks in the lobby so that the hospital gets its take? Or is it

> > okay to

> > > charge for the aspirin given to the chest pain patient that left AMA?

> > Well I

> > > never...

> > >

> > > Dudley

> > >

> > > Re: Ethical, illegal or greedy?

> > >

> > > A number of years ago (been a while) a smaller service in the eastern

> > Texas

> > > area (fortunately long ago shut down), was well known for charging as

> > much as

> > > $500.00 for no-rides and in one case (as the story was told) they sent

> > on of

> > > their " no-ride " bills to an elderly lady who had just lost her husband

> > who

> > > was coded on their living room floor. This occurred after the local

> > police

> > > department had to respond to an area river to alert them to the call -

> > it seems

> > > they were fishing and were away from their radio.

> > >

> > > I think unethical and greedy fit that case.

> > >

> > > Don

> > >

> > > >>> " Wayne D " <rxmd911@... <rxmd911%40yahoo.rxm>> 07/24/07 8:53 AM

> > >>>

> > > Thanks for the replys. This was just something that was brought up

> > yesterday

> > > during an EMS discussion and talk about EMS fraud.

> > >

> > > Wayne

> > >

> > > Wayne D <rxmd911@... <rxmd911%40yahoo.rxm>> wrote:

> > > Company X goes on a public assist call because granny has fallen and

> > can't

> > > get up. The crew for company X arrives and gets granny up out of the

> > floor.

> > > She does not want to be transported to the ER. Crew gets her information

> > and

> > > signed AMA. Company X then charges granny $75 as a no transport charge.

> > Is this

> > > legal? Is the company just greedy for money? Does the pt for her

> > insurance

> > > company pay?

> > >

> > > How about one that you AMA from a fight because they did not call for

> > EMS

> > > and don't want to be billed for services they did not request? However,

> > they

> > > get billed the same amount as granny did for AMA. Pt refuses to provide

> > info,

> > > so crew calls the local hospital for billing info. Does this violate

> > HIPPA

> > > since the pt was never seen in the ER this trip?

> > >

> > > There are providers out there that do this. What is everyones view on

> > this.

> > >

> > > Wayne

> > >

> > > ------------ -------- -------- --

> > > Need a vacation? Get great deals to amazing places on Yahoo! Travel.

> > >

> > >

[Guest guest]

Although, on second reading, I can see where it might be painful and

morally reprehensible to agree with Henry and Dudley ..

Re: Ethical, illegal or greedy?

* As morally reprehensible as it may seem and as painful as it may

be...I think I have to agree with Henry and Dudley in the same posting.

The future of EMS will see us doing far more non-transported streetside

clinical work, as we are the natural extension of medicine into the

street. Charging for non-transport situations will become inevitable for

most, if not all, of us.

Vernon Gresham

City of Ganado

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[Guest guest]

We bill both...depending upon the info the patient shares with us. Its not the

total solution to our financial issues...but we do get some. Would have to

pull the most current numbers but would suspect we are around 25 to 30%

collection.Â

I have another email I just received yesterday on this very topic. In Idaho,

they have negotiated payments from Medicaid for " Aid " calls...this is a HUGE

accomplishment. Something for us to strive towards in Texas I would say.

Dudley

RE: Ethical, illegal or greedy?

Are you billing this straight to the patient? Insurance?

ble to collect?

ruly curious…..

rom: texasems-l [mailto:texasems-l ] On

ehalf Of THEDUDMAN@...

We also charge an Air Med Assist fee for those patients who get flown

ut (about 18 of 6,200 requests annually) of $250 because it makes no

ense for us to extricate, strap to a board, start 2 IV's, intubate,

harmacologically assist, etc, etc and send them off in a

elicopter..-.and not charge...the air med service isn't discounting

heir bill for the work we did

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[Guest guest]

After all, EMT does not stand for " Emegency Medical Transport. " If an

attorney can charge the same rate in a bar as in his office, why can't

an EMT charge for service on the street the same in as a vehicle?

Osborn, Dallas, TX

>

> Although, on second reading, I can see where it might be painful and

> morally reprehensible to agree with Henry and Dudley ..

>

>

>

> Re: Ethical, illegal or greedy?

>

> * As morally reprehensible as it may seem and as painful as it may

> be...I think I have to agree with Henry and Dudley in the same

posting.

> The future of EMS will see us doing far more non-transported

streetside

> clinical work, as we are the natural extension of medicine into the

> street. Charging for non-transport situations will become inevitable

for

> most, if not all, of us.

>

> Vernon Gresham

> City of Ganado

>

>

> No virus found in this incoming message.

> Checked by AVG Free Edition.

> Version: 7.5.476 / Virus Database: 269.10.16/914 - Release Date:

> 7/23/2007 7:45 PM

>

> No virus found in this outgoing message.

> Checked by AVG Free Edition.

> Version: 7.5.476 / Virus Database: 269.10.16/914 - Release Date:

> 7/23/2007 7:45 PM

>

>

>

[Guest guest]

If they are not injured are they patients? Two issues, a person who is a

patient and you treat them and someone who was in an accident and is not

injured.

AJL

>

> Dudley,

>

> I don't have a problem with billing for services that are requested. I

> thought I made that clear. But what about this:

>

> There's a little fender bender, and a passerby calls 911 from his cell

> while

> passing by. He's not involved and not on scene when you get there. On

> arrival, all passengers are out of the cars, uninjured, all refuse

> service, and

> all say they did not request that EMS respond. Would you bill those

> people?

>

> Gene

> In a message dated 7/24/07 9:26:21 AM,

THEDUDMAN@...<THEDUDMAN%40aol.com>writes:

>

> >

> >

> > This discussion greatly bothers me. Why should EMS, like all other

> facets

> > of healthcare, not be able to charge to cover their expenses? I like

> Henry's

> > statement about the freezer repair man...what a great analogy. Despite

> the

> > fact that no one pays for it out of pocket (in most cases) it costs

> dollars

> > each and every time the " rig " is pulled out of the barn. Diesel is

> almost $3 a

> > gallon, wear and tear adds up, the cost of people (except volunteers..

> This

> > discussion greatly bothers me. Why should EMS, like all other facets of

>

> > healthcare, not be able to charge to cover their expenses? I like

> Henry's

> > statement about the freezer repair man...what a great analogy. Despite

> the fact

> >

> > One of the primary issues we will have in survival of EMS is the fact

> that

> > we have TRADITIONALLY had our services tied to transporting people. As

> we go

> > forward, scope of practice expands, and we are taking less and less to

> the

> > hospital in favor of other options...(read the EMS Agenda for the

> Future)...if

> > our only " non-greedy " form of payment is tied to turning wheels we will

> > die...

> >

> > We charge an " aid call " fee for those patients who we respond to and

> treat.

> > It is $125. We also charge an Air Med Assist fee for those patients who

> get

> > flown out (about 18 of 6,200 requests annually) of $250 because it makes

> no

> > sense for us to extricate, strap to a board, start 2 IV's, intubate,

> > pharmacologically assist, etc, etc and send them off in a helicopter..

> We charge an

> > " aid call " fee for those patients who we respond to and treat. It is

> $125.

> > We also charge an Air Med Assist fee for those patients who get flown

> out

> > (about 18 of 6,200 requests annually) of $250 because it makes no sense

> for us to

> > extricate, strap to a board, start 2 IV's, intubate, pharmacologically

> > assist, etc, etc and send them off in a helicopter..<wbr>.and not

> charge...the air

> > med

> >

> > Really folks, we have to get past the fact that us getting paid for the

> > services we provide is somehow wrong or immoral. The volunteer, all

> here for the

> > community, concept was great as we started....but we have to move past

> it.

> > Times have changed and if we continue to stand in this tar pit of " we

> can't

> > charge, that's wrong " we will soon become extinct like other dinosaurs

> of the

> > past.

> >

> > Think about this...on the hospital administrator list serve or the

> physician

> > list serve...how many discussions do you suppose they have regarding how

>

> > immoral or unethical it is to charge an extra $1.25 a cup of coffee in

> the

> > starbucks in the lobby so that the hospital gets its take? Or is it

> okay to

> > charge for the aspirin given to the chest pain patient that left AMA?

> Well I

> > never...

> >

> > Dudley

> >

> > Re: Ethical, illegal or greedy?

> >

> > A number of years ago (been a while) a smaller service in the eastern

> Texas

> > area (fortunately long ago shut down), was well known for charging as

> much as

> > $500.00 for no-rides and in one case (as the story was told) they sent

> on of

> > their " no-ride " bills to an elderly lady who had just lost her husband

> who

> > was coded on their living room floor. This occurred after the local

> police

> > department had to respond to an area river to alert them to the call -

> it seems

> > they were fishing and were away from their radio.

> >

> > I think unethical and greedy fit that case.

> >

> > Don

> >

> > >>> " Wayne D " <rxmd911@... <rxmd911%40yahoo.rxm>> 07/24/07 8:53 AM

> >>>

> > Thanks for the replys. This was just something that was brought up

> yesterday

> > during an EMS discussion and talk about EMS fraud.

> >

> > Wayne

> >

> > Wayne D <rxmd911@... <rxmd911%40yahoo.rxm>> wrote:

> > Company X goes on a public assist call because granny has fallen and

> can't

> > get up. The crew for company X arrives and gets granny up out of the

> floor.

> > She does not want to be transported to the ER. Crew gets her information

> and

> > signed AMA. Company X then charges granny $75 as a no transport charge.

> Is this

> > legal? Is the company just greedy for money? Does the pt for her

> insurance

> > company pay?

> >

> > How about one that you AMA from a fight because they did not call for

> EMS

> > and don't want to be billed for services they did not request? However,

> they

> > get billed the same amount as granny did for AMA. Pt refuses to provide

> info,

> > so crew calls the local hospital for billing info. Does this violate

> HIPPA

> > since the pt was never seen in the ER this trip?

> >

> > There are providers out there that do this. What is everyones view on

> this.

> >

> > Wayne

> >

> > ------------ -------- -------- --

> > Need a vacation? Get great deals to amazing places on Yahoo! Travel.

> >

> >

[Guest guest]

If they called, or their immediate family member called, I have no

qualms in billing them. Injured or not. You are billing for an

assessment, followed by necessary treatment. I don’t believe that

injuries and /or illness being present should be the pivotal point.

Mike

Re: Ethical, illegal or greedy?

> >

> > A number of years ago (been a while) a smaller service in the

eastern

> Texas

> > area (fortunately long ago shut down), was well known for charging

as

> much as

> > $500.00 for no-rides and in one case (as the story was told) they

sent

> on of

> > their " no-ride " bills to an elderly lady who had just lost her

husband

> who

> > was coded on their living room floor. This occurred after the local

> police

> > department had to respond to an area river to alert them to the call

-

> it seems

> > they were fishing and were away from their radio.

> >

> > I think unethical and greedy fit that case.

> >

> > Don

> >

> > >>> " Wayne D " <HYPERLINK

" mailto:rxmd911%40yahoo.rxm " rxmd911 (AT) yahoo (DOT) -rxm <rxmd911%40yahoo.-rxm>>

07/24/07 8:53 AM

> >>>

> > Thanks for the replys. This was just something that was brought up

> yesterday

> > during an EMS discussion and talk about EMS fraud.

> >

> > Wayne

> >

> > Wayne D <HYPERLINK " mailto:rxmd911%40yahoo.rxm " rxmd911 (AT) yahoo (DOT) -rxm

<rxmd911%40yahoo.-rxm>> wrote:

> > Company X goes on a public assist call because granny has fallen and

> can't

> > get up. The crew for company X arrives and gets granny up out of the

> floor.

> > She does not want to be transported to the ER. Crew gets her

information

> and

> > signed AMA. Company X then charges granny $75 as a no transport

charge.

> Is this

> > legal? Is the company just greedy for money? Does the pt for her

> insurance

> > company pay?

> >

> > How about one that you AMA from a fight because they did not call

for

> EMS

> > and don't want to be billed for services they did not request?

However,

> they

> > get billed the same amount as granny did for AMA. Pt refuses to

provide

> info,

> > so crew calls the local hospital for billing info. Does this violate

> HIPPA

> > since the pt was never seen in the ER this trip?

> >

> > There are providers out there that do this. What is everyones view

on

> this.

> >

> > Wayne

> >

> > ------------ -------- -------- --

> > Need a vacation? Get great deals to amazing places on Yahoo! Travel.

> >

> >

[Guest guest]

In a message dated 7/24/2007 6:24:23 P.M. Central Daylight Time,

josborn@... writes:

If an attorney can charge the same rate in a bar as in his office, why can't

an EMT charge for service on the street the same in as a vehicle?

The simple answer to that bar thing is that in most cases you get much

better advice at the bar after the 4th round or so.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

LNMolino@...

(Cell Phone)

(IFW/TFW/FSS Office)

(IFW/TFW/FSS Fax)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author

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[Guest guest]

Who would you bill when it is the police that call after everyone states that

they do not want an ambulance???

Peggy

wegandy1938@... wrote:

Henry,

That's entirely reasonable, and I think that's what I was trying to say. I

might not have made it clear that I felt it perfectly legitimate to bill for

service asked for.

I would not, however, bill somebody at a little MVC where a 3rd party

passerby called EMS on his cellular, you get there, and everybody refuses and

says

they didn't call.

I don't think you bill for those instances, do you? I think you COULD, if

an ordinance were enacted permitting it, but I'd have to do some " deep

thinking " about that. I know that I would refuse to pay such a bill if I were

one of

the people who clearly indicated that I was not a patient and didn't call.

However, if I ask you to check me out and help me decide whether or not to go

to the hospital, that's a request for service, and when you provide that

service it's legitimate and proper for you to bill.

If I go to Mcs, order a cup of coffee but then decide not to drink it,

I still have to pay for it. No argument there at all.

But yes, the guy who calls every time he wants a light bulb changed certainly

should be carged for the call.

GG

>

> Gene and Wayne,

>

> We consider ourselves a reputable service and we charge a service refusal

> charge. Our Charge is 50.00. We only charge this fee if your or a member of

> your family request that we respond to your residence. It is only reasonable

to

> expect that if you call or your family calls that we should be able to charge

> for our services. That service being a response, an assessment and our

> opinion of your need for further care or transport. The guy that comes out to

> check out your freezer that isn't cooling and finds that you have many

packages

> of trout blocking the vent is all that is wrong, still charges you a fee.

>

> We on occasion (we bill all inclusive) will start an I.V. and deliver

> glucose to a patient only to have his\her blood sugar return to normal with a

> return to normal orientation accompanied with a statement of I am not going to

the

> hospital. These patients we charge a refusal fee of 50.00.

>

> Hey what about that frequent flyer who falls every day and just needs help

> getting up off the floor. We arrive and the family stands around while we put

> them back in their chair or bed.

>

> What about that frequent flyer that calls just because he is not feeling

> well and just wants to be checked out.

>

> Well we bills those a refusal charge also. If they are responsible and they

> feel the need to pay their bills they will figure out that maybe they don't

> need to call unless their is a reasonable expectation that they want to go to

> the hospital.

>

> A large portion of the accounts we send to collections are indeed the

> refusal fees. Does that bother me, not in the least so long as it meets the

above

> criteria listed in the first paragraph. We are a county run service and simply

> cannot give our services away, at the same time we feel all our charges are

> reasonable and lower than most if not all other providers around us.

>

> Henry

> Re: Ethical, illegal or greedy?

>

> It's up to the company whether or not it wishes to charge for this service.

> Many services do not, for reasons of good public relations; however, some

> do.

> If Granny called EMS, they can bill her. If somebody else called for her

> at her behest, she can still be billed. If a medical alert service called

> you, she can be billed. If she didn't call and doesn't know who did, if she

> accepts the service, she can be billed, but the service should explain to

> her

> that she will be billed in any case. I suppose she could elect to stay in

> the

> floor, but in practice that's not going to happen. If it were my service, I

> wouldn't bill for it, but there are those that would.

>

> Some cities bill for garbage service whether you use it or not. So on that

> basis, I suppose the City of Dog Patch EMS, being a municipal service could

> bill for every response if they passed the proper ordinances. They could

> also

> bill for fire service and probably police services, although I'm not sure

> about that and I don't intend to spend time researching it.

>

> In the second instance, the patient is probably on good grounds not to pay

> the bill unless, as stated above, the city has a policy of billing for all

> responses, and even then, I think it's legally doubtful that the charge

> would

> stick. If Pizza Hut delivers a Giant Supreme to my house and I didn't order

> it, I

> don't have to accept it or pay for it. EMS service is basically the same,

> although not as tasty.

>

> HIPAA would not be violated by securing patient information from the

> hospital, since one of the three exceptions to HIPAA that allow use of

> information and

> freeflow of information is for billing purposes. However, I wouldn't be

> surprised at all if the hospital refused to provide the information.

>

> But let's say that this guy is a frequent flyer. Certainly the service

> could retrieve his records and get his address from them. The prospect of

> his

> paying in any event is nil, so why bother? It will cost more to bill him

> than

> the service will ever get.

>

> Is all of this pretty sleazy? Yep, in my judgment, but sleaze and legal are

> not the same, some folks' opinions to the contrary.

>

> Gene

>

>

> >

> > Company X goes on a public assist call because granny has fallen and can't

> > get up. The crew for company X arrives and gets granny up out of the

> floor.

> > She does not want to be transported to the ER. Crew gets her information

> and

> > signed AMA. Company X then charges granny $75 as a no transport charge. Is

> this

> > legal? Is the company just greedy for money? Does the pt for her insurance

> > company pay?

> >

> > How about one that you AMA from a fight because they did not call for EMS

> > and don't want to be billed for services they did not request? However,

> they

> > get billed the same amount as granny did for AMA. Pt refuses to provide

> info,

> > so crew calls the local hospital for billing info. Does this violate HIPPA

> > since the pt was never seen in the ER this trip?

> >

> > There are providers out there that do this. What is everyones view on

> this.

> >

> > Wayne

> >

> > ------------ -------- -------- --

> > Need a vacation? Get great deals to amazing places on Yahoo! Travel.

> >

> >

[Guest guest]

Hey Mike you missed Vernons point on this one. He was having to struggle to

agree with me. Even though I taught the boy everything he knows. I should have

failded him in his first EMT course and saved us all the pain.

Henry

Re: Ethical, illegal or greedy?

* As morally reprehensible as it may seem and as painful as it may

be...I think I have to agree with Henry and Dudley in the same posting.

The future of EMS will see us doing far more non-transported streetside

clinical work, as we are the natural extension of medicine into the

street. Charging for non-transport situations will become inevitable for

most, if not all, of us.

Vernon Gresham

City of Ganado

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[Guest guest]

MVC's we do not bill for unless we transport.

Henry

Re: Ethical, illegal or greedy?

>

> It's up to the company whether or not it wishes to charge for this service.

> Many services do not, for reasons of good public relations; however, some

> do.

> If Granny called EMS, they can bill her. If somebody else called for her

> at her behest, she can still be billed. If a medical alert service called

> you, she can be billed. If she didn't call and doesn't know who did, if she

> accepts the service, she can be billed, but the service should explain to

> her

> that she will be billed in any case. I suppose she could elect to stay in

> the

> floor, but in practice that's not going to happen. If it were my service, I

> wouldn't bill for it, but there are those that would.

>

> Some cities bill for garbage service whether you use it or not. So on that

> basis, I suppose the City of Dog Patch EMS, being a municipal service could

> bill for every response if they passed the proper ordinances. They could

> also

> bill for fire service and probably police services, although I'm not sure

> about that and I don't intend to spend time researching it.

>

> In the second instance, the patient is probably on good grounds not to pay

> the bill unless, as stated above, the city has a policy of billing for all

> responses, and even then, I think it's legally doubtful that the charge

> would

> stick. If Pizza Hut delivers a Giant Supreme to my house and I didn't order

> it, I

> don't have to accept it or pay for it. EMS service is basically the same,

> although not as tasty.

>

> HIPAA would not be violated by securing patient information from the

> hospital, since one of the three exceptions to HIPAA that allow use of

> information and

> freeflow of information is for billing purposes. However, I wouldn't be

> surprised at all if the hospital refused to provide the information.

>

> But let's say that this guy is a frequent flyer. Certainly the service

> could retrieve his records and get his address from them. The prospect of

> his

> paying in any event is nil, so why bother? It will cost more to bill him

> than

> the service will ever get.

>

> Is all of this pretty sleazy? Yep, in my judgment, but sleaze and legal are

> not the same, some folks' opinions to the contrary.

>

> Gene

>

>

> >

> > Company X goes on a public assist call because granny has fallen and can't

> > get up. The crew for company X arrives and gets granny up out of the

> floor.

> > She does not want to be transported to the ER. Crew gets her information

> and

> > signed AMA. Company X then charges granny $75 as a no transport charge. Is

> this

> > legal? Is the company just greedy for money? Does the pt for her insurance

> > company pay?

> >

> > How about one that you AMA from a fight because they did not call for EMS

> > and don't want to be billed for services they did not request? However,

> they

> > get billed the same amount as granny did for AMA. Pt refuses to provide

> info,

> > so crew calls the local hospital for billing info. Does this violate HIPPA

> > since the pt was never seen in the ER this trip?

> >

> > There are providers out there that do this. What is everyones view on

> this.

> >

> > Wayne

> >

> > ------------ -------- -------- --

> > Need a vacation? Get great deals to amazing places on Yahoo! Travel.

> >

> >

[Guest guest]

Misunderstood...I meant it was morally reprehensive and painful to agree with

Henry and Dudley in the same posting! I see the economic advantage and

improvement to the overall health of a community that will be seen with

" streetside clinical work " . It will also require a broader scope of practice

for this industry...leading to some of the positive changes that this list

laments about on a constant basis.

VG

Re: Ethical, illegal or greedy?

* As morally reprehensible as it may seem and as painful as it may

be...I think I have to agree with Henry and Dudley in the same posting.

The future of EMS will see us doing far more non-transported streetside

clinical work, as we are the natural extension of medicine into the

street. Charging for non-transport situations will become inevitable for

most, if not all, of us.

Vernon Gresham

City of Ganado

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7/23/2007 7:45 PM

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7/23/2007 7:45 PM

[Guest guest]

Sorry...just saw this.? No, we would not bill third party calls...

I would also recommend agencies define a " patient " in their protocols...because

making that determination drives the rest of the process.

Dudley

Re: Ethical, illegal or greedy?

> > >

> > > A number of years ago (been a while) a smaller service in the eastern

> > Texas

> > > area (fortunately long ago shut down), was well known for charging as

> > much as

> > > $500.00 for no-rides and in one case (as the story was told) they sent

> > on of

> > > their " no-ride " bills to an elderly lady who had just lost her husband

> > who

> > > was coded on their living room floor. This occurred after the local

> > police

> > > department had to respond to an area river to alert them to the call -

> > it seems

> > > they were fishing and were away from their radio.

> > >

> > > I think unethical and greedy fit that case.

> > >

> > > Don

> > >

> > > >>> " Wayne D " <rxmd911@... <rxmd911%40yahoo.rxm>> 07/24/07 8:53 AM

> > >>>

> > > Thanks for the replys. This was just something that was brought up

> > yesterday

> > > during an EMS discussion and talk about EMS fraud.

> > >

> > > Wayne

> > >

> > > Wayne D <rxmd911@... <rxmd911%40yahoo.rxm>> wrote:

> > > Company X goes on a public assist call because granny has fallen and

> > can't

> > > get up. The crew for company X arrives and gets granny up out of the

> > floor.

> > > She does not want to be transported to the ER. Crew gets her information

> > and

> > > signed AMA. Company X then charges granny $75 as a no transport charge.

> > Is this

> > > legal? Is the company just greedy for money? Does the pt for her

> > insurance

> > > company pay?

> > >

> > > How about one that you AMA from a fight because they did not call for

> > EMS

> > > and don't want to be billed for services they did not request? However,

> > they

> > > get billed the same amount as granny did for AMA. Pt refuses to provide

> > info,

> > > so crew calls the local hospital for billing info. Does this violate

> > HIPPA

> > > since the pt was never seen in the ER this trip?

> > >

> > > There are providers out there that do this. What is everyones view on

> > this.

> > >

> > > Wayne

> > >

> > > ------------ -------- -------- --

> > > Need a vacation? Get great deals to amazing places on Yahoo! Travel.

> > >

> > >

[Guest guest]

Dudley very smart man.

What a novel approach!!! To define who is a patient and who is not.

I have lectured to some extent on that subject, and I find that there is

always mass confusion in the minds of medics and administrators alike as to when

one becomes a patient.

Many seem to think that every minor child you see is a patient just because

they cannot either consent nor refuse on their own behalf; therefore, when

the school bus knocks down a Volkswagen, all 52 kids on the bus have to be

written up as patients just because their parents are not there to refuse for

them.

NOT!

They are no more patients if they're not hurt than somebody walking along the

sidewalk who witnesses a fender-bender is.

It is not fair to employees to make them guess what's going to make a patient

a patient. So get out the yellow pads and the crayons and write up a

policy.

Gene G.

>

>

> Sorry...just saw this.? No, we would not bill third party calls...

>

> I would also recommend agencies define a " patient " in their protocols... I

> would also recommend agencies define a " patient " in their prot

>

> Dudley

>

> Re: Ethical, illegal or greedy?

> > > >

> > > > A number of years ago (been a while) a smaller service in the eastern

> > > Texas

> > > > area (fortunately long ago shut down), was well known for charging as

> > > much as

> > > > $500.00 for no-rides and in one case (as the story was told) they sent

> > > on of

> > > > their " no-ride " bills to an elderly lady who had just lost her husband

> > > who

> > > > was coded on their living room floor. This occurred after the local

> > > police

> > > > department had to respond to an area river to alert them to the call -

> > > it seems

> > > > they were fishing and were away from their radio.

> > > >

> > > > I think unethical and greedy fit that case.

> > > >

> > > > Don

> > > >

> > > > >>> " Wayne D " <rxmd911@... <rxmd911%40yahoo.rxm>> 07/24/07 8:53

> AM

> > > >>>

> > > > Thanks for the replys. This was just something that was brought up

> > > yesterday

> > > > during an EMS discussion and talk about EMS fraud.

> > > >

> > > > Wayne

> > > >

> > > > Wayne D <rxmd911@... <rxmd911%40yahoo.rxm>> wrote:

> > > > Company X goes on a public assist call because granny has fallen and

> > > can't

> > > > get up. The crew for company X arrives and gets granny up out of the

> > > floor.

> > > > She does not want to be transported to the ER. Crew gets her

> information

> > > and

> > > > signed AMA. Company X then charges granny $75 as a no transport

> charge.

> > > Is this

> > > > legal? Is the company just greedy for money? Does the pt for her

> > > insurance

> > > > company pay?

> > > >

> > > > How about one that you AMA from a fight because they did not call for

> > > EMS

> > > > and don't want to be billed for services they did not request?

> However,

> > > they

> > > > get billed the same amount as granny did for AMA. Pt refuses to

> provide

> > > info,

> > > > so crew calls the local hospital for billing info. Does this violate

> > > HIPPA

> > > > since the pt was never seen in the ER this trip?

> > > >

> > > > There are providers out there that do this. What is everyones view on

> > > this.

> > > >

> > > > Wayne

> > > >

> > > > ------------ -------- -------- --

> > > > Need a vacation? Get great deals to amazing places on Yahoo! Travel.

> > > >

> > > >