Free MC ambulance ending?

By Jane DeGeorge
Eagle Reporter
Published: July 17, 2008

Madison County may soon charge for ambulance rides.

An eight-person finance committee – established by the board of supervisors this past November – has recommended that the county start a “revenue recovery” program, which would bill patients’ insurance providers between $300-$500 per emergency ambulance trip to a hospital.

Currently, both the all-volunteer Madison County Rescue Squad – which is on duty from 6 p.m.-5 a.m. every day – and the paid Madison Emergency Medical Services squad – which is on duty 5 a.m.-6 p.m. every day – do not charge for treatment and ambulance transportation.

The finance committee was established to come up with additional ways the county can pay for the services it provides as well as review and suggest changes to its current taxes and fees.

Finance Committee Chairman Bill Price told the supervisors that out of the group’s six initial recommendations, he believes the “revenue recovery” program has the most “potential.”

“We spent a lot of time on that. I don’t think anybody likes it, but it’s one of these inevitable things in life,” Price told the board at its regularly scheduled July 8 meeting.

The committee chairman said he was especially convinced it was a good idea after he was told that 20 percent of rescue squad calls are for out-of-county residents.

Based on some estimates, this type of system could generate between $300,000-$500,000 per year for the county, which could be used to lower taxes or to purchase equipment, fuel or provide training, the report states. The county’s current budget includes about $100,000 for the volunteer squad and about $950,000 for the paid squad.

Public outreach needed

Price said the key to starting this program would be creating a committee to inform the community about the change.

“The [public’s] general feeling [about this type of program] is that if the squad comes and picks me up and takes me to the hospital and I can’t afford it, I’m going to lose my house,” he said, adding that the committee needs to work to dismiss that type of mindset.

A possible “revenue recovery” system would bill a patient’s insurance company, Medicaid or Medicare, according to the report. Most emergency medical services agencies that charge for services, use “soft billing” – which means “everyone is sent a bill but they do not aggressively collect from those who do not have some kind of insurance coverage,” the report states.

The committee suggests that “extensive outreach efforts need to be made to citizens so that all understand that no one will be barred from treatment or transport for financial reasons” and that “no one will be sent to a collection agency.”

Some nearby counties that already charge for ambulance rides include Culpeper, Orange and Louisa counties. Albemarle County officials have also discussed charging for its rescue squad transports, according to recent news reports.

Volunteers oppose billing

These types of programs have met some resistance from volunteer squads, including some Madison County Rescue Squad volunteer members, according to the committee’s report.

Most Madison Volunteer Rescue Squad members “do not support the idea, although many accept that it will eventually happen,” the report states.

Most of those who oppose charging for ambulance rides note that they like participating in an-all volunteer organization that provides a free service to the community because it’s “the public-spirited, right thing to do,” the report says. Others are also concerned that people may hesitate to call 911 due to financial reasons, according to the report. 

At the supervisors’ July meeting, former supervisor and life member of the Madison County Rescue Squad James Hale told the supervisors he considers his past volunteer service with the squad sufficient payment for any emergency services he may ever use in the future.

“I ran with the squad for 16 years and I consider that my contribution to Madison County…If I have to pay to be carted to the hospital, I’m not going to donate to the volunteer rescue squad,” he told the board.

The committee’s report mentions that in other counties that charge for ambulance services, fund-raising for the volunteer rescue squads has not decreased, although the committee suggests that county officials would need to make it clear to the community their donations would still be needed to support the volunteer squad.

At the July meeting, Supervisor Bill Crigler, who is a Madison County Rescue Squad director, said that county officials proposed the “revenue recovery” program to the squad a year ago and the squad members “voted it down.”

Officials are currently working to revise an out-of-date “memorandum of understanding” between the rescue squad and the supervisors that may include some type of “revenue recovery” agreement, Crigler said. 

The supervisor added that there are other issues that complicate introducing this type of program, including that the squad would need to agree to lease its vehicles to the county, he said.

“My goal is to try to get this up and running before my term is up – so we have about a year,” said Crigler, who is up for re-election in fall 2009.

Program discussed before

This is not the first time a “revenue recovery” program has been suggested in Madison County. During the county’s public hearings regarding its 2005-2006 fiscal year budget in May 2005, several county residents suggested that Madison County start charging for its rescue squad services, according to an Eagle story from the time.

However, some county officials – including Madison County Emergency Medical Services Director Lewis Jenkins and Madison County Volunteer Fire Company Chief Jack Fray – said that if the volunteer rescue squad started charging for ambulance rides, its members would no longer be protected by “Good Samaritan” laws, which prevent citizens from suing those who volunteer to help with emergencies.

At the May 2005 meeting, officials said that if only the paid squad charged for its ambulance rides, many citizens would wait to call 911 until the volunteer squads’ overnight hours flooding those squad members with excessive calls.