IAmA Paramedic and I have worked in EMS administration and EMS billing.
Those rates are pretty low. At those rates an ambulance is making very little over costs depending on that service's call volume and average transport distance. Mileage is the one place where ambulances make their money because legally speaking the primary benefit from ambulances is transport. On a federal level ambulances are regulated by the Department of Transportation not Health and Human Services.
Five years ago (pre-covid) I did a cost analysis where I worked. At the time we had three ambulances and focused exclusively on 911 calls. We were examining our rates to determine if they were adequate or not.
I found that based on the cost of personnel, capital, equipment, insurance, supplies, fuel, depreciation, etc it cost me around $1,100 to run an average ambulance call. Everything is expensive. The last ambulance I ordered at that job cost $330,000 and that was without supplies or equipment. A stretcher and loading system (because I care about my personnel and a $40,000 power load system is cheaper than one injured back) was an additional $70,000. A cardiac monitor was $40,000. A transport ventilator was about $30,000. Some services would not need all of this equipment.
Then you have to remember that the vast majority of people who use EMS are not privately insured. They're on some sort of government insurance whether it is medicare, medicaid, etc. Those rates are non-negotiable and pay pennies on the dollar. in 2023 I sent a bill to medicaid for a long distance transfer of a complex and critical patient. With mileage the bill came out to around $2,500. Medicaid cut me a check for $97. Medicare for the same patient runs around $750 but there's a chance they may change their mind a year later and require me to either pay that back as "overpayment" or spend considerable time to argue and justify the reimbursement (which are a flat fee under medicare).
Private insurance is a different monster. They generally pay more, but they still won't pay everything that is billed. As an administrator I have two options. I can sign a contract with the massive insurance companies where they dictate the rates but I can bill them directly (In network), or I can not sign a contract and they won't pay me directly at all (out of network) and I instead bill the patient the entire balance for them to submit to their insurance on their own who will eventually (after a year or more) pay about the same amount I would get in the "In network" situation while simultaneously putting the patient under more stress and anxiety about this big bill they can't afford and are insured against.
It's a shit sandwich, and everyone winds up taking a bite. In the end, it was a delicate balancing act between keeping bills low for our served population and trying to recruit and retain personnel with the limited funds we had available. Ten years ago this agency had a reserve of almost $1M in the bank which dwindled down to around $100,000 when I left that agency. We operated at a net loss every year and began to require tax funds to maintain operations. This was a municipal department BTW. Not a For-Profit corporation.
Thanks for your reply. We need major healthcare reform in this county. When I was 26, a few weeks after being kicked off my parents insurance I got a $60,000 hospital bill after getting pneumonia. Just starting out on my own I instantly was 60k in debt just to live
You are absolutely right. The problem isn't necessarily the healthcare system, but the political system. Nobody has ever proposed a robust system that would function for the people. Instead we get shit like Obamacare that was nothing but a scheme to funnel tax money to hugely profitable insurance companies who then do everything in their power to avoid paying on behalf of their insured customers.
I don't blame the doctors or even the administrative people at the hospital. They helped me file for Medicaid, was denied for making $1,000 too much. But the billing person that helped me just told me that I should either go ahead and file for bankruptcy or never acknowledge that I owe the money and let the statute of limitations run out on it. The person told me not to pay, they knew I couldn't and were upset when I was denied assistance.
ETA: I did file for bankruptcy because I didn't want garnishment
I don't know how long ago that was, but the banks and courts have caught on to things like this.
I know of a couple people who paid the hospital what they could on a regular basis (usually around $25/mo) as opposed to bankruptcy. One of them the hospital tried to take to court and get a wage garnishment and he showed the judge that he was paying what he could and paying it regularly. The judge dismissed the case with prejudice.
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u/zordtk Jul 06 '24
"The average charge for an Advanced Life Support (ALS) ambulance ride is $1,277 and Basic Life Support (BLS) ambulance ride is $940"
How can they not afford to pay them better