`911, What`s Your Insurance?`

After years of providing free emergency ambulance transport through the Annapolis Fire Department, the city is considering charging for medical service in an attempt to catch up with the rising costs of medical treatment.

In the move referred to as "compassionate billing," officials stress that service will continue as usual, and no one will be turned away.

Mayor Ellen O. Moyer, who introduced the bill to the City Council last month, has proposed a "soft collection" policy. That means if the resident has no insurance and is unable to pay or is the victim of a crime, no action will be taken to recoup the money.

"No one is ever, ever going to be turned away," said Ray Weaver, city spokesman. "It's simply not that kind of thing. The process for picking someone up is exactly the same and the billing will occur after the fact. Insurance companies are being billed, not the individual person."

According to a city staff report, about 70 percent of local jurisdictions already bill for EMS service, including Prince George's County, Baltimore city, Fairfax County and Washington.

Medicare, Medicaid and most commercial insurance programs pay for medically necessary ambulance service. Services dispatched via 911 are almost always covered by insurance, although about 15 percent of city residents are without health insurance.

Last year, more than 9,500 calls were made to 911 with about 7,100 requiring emergency medical service, said Firefighter John Bowes, a city Fire Department spokesman.

But some officials fear those without health insurance won't report medical emergencies, whether out of pride or simply confusion about how the system works.

Currently, Anne Arundel County does not charge patients or insurance companies for emergency medical treatment, though a task force examined charging a user fee or privatizing ambulance services in the mid-1990s as funds dwindled while demand for service grew. The plan was scrapped after officials determined privatizing ambulance service could diminish quality.

Those residents in the county on the Annapolis Neck Peninsula, however, could be the ones hit hardest if the city's bill is passed. County residents who receive city service would be billed directly, whereas city residents would be billed via their insurance providers.

"My concern is if someone is having a heart attack, the call will go through '911, what's your insurance?'" said Alderman David Cordle, R-Ward 5 and chairman of the Public Safety Committee. "What are county residents going to think when they receive a bill from the city? We're dealing with a bigger picture - we have more of a problem of jurisdiction with the county."

The city is looking to model the billing services after Fairfax County's program, which went into effect April 2005, Mr. Weaver said.

Fairfax, a county of more than 1 million people, generated about $9.7 million in revenue from its first full fiscal year of billing for ambulance service, said Dan Schmidt, Fairfax County Fire and Rescue spokesman.

City Finance Director Tim Elliott estimated the city would make about $483,000 from its billing. He said about 30 percent of bills would go uncollected. He also estimated the cost of paying a collection agency would be about 8 percent of the revenue.

Based on reports from other local governments, the city figured insurance would cover about $254 per EMS transport.

"The money is there and we need it," Mr. Weaver said. "The bottom line is as things get more and more expensive, we want to be able to provide the absolute best service we can."

Fairfax County attempts to run its billing service invisible to the first responder and the patient - the administrative process is not even considered until care has been given at the hospital.

Mr. Schmidt said in the 18 months since billing has been implemented it has been well received, due largely to a six-month-long public information and media blitz, outlining every detail of the program for residents.

"It's important for people to understand what this is all about," he said. "We looked at this and made sure that the campaign the preceded the actual billing portion was very thorough and we made sure people knew what was going on and how it was administered - which was key."

Fairfax officials canvassed neighborhoods, distributing flyers in nearly every language it served, kept Web sites running with up-to-date information. They also sent a mailer to every household, as well as reached out to minority community groups and help centers.

In Annapolis, Mr. Weaver said the city is expecting a four-to-six-month campaign of getting the word out on billing if the measure passes.

"We've discussed having (the information) in Spanish and letting people know as much as we can, possibly going door-to-door," he said. "This is a preliminary thing brought before the council, and there's still a whole lot of conversation that needs to be had, but we will certainly let everybody know how it is going to be structured."

Mr. Cordle said he is against a third-party collection agency and fears residents may have to face harassing phone calls if their insurance provider does not pay the bill.

Fairfax has a third party collecting for the county and has been pleased with the results, Mr. Schmidt said.

"One can argue when you pay taxes you pay for city services," said Mr. Cordle. "My personal greatest concern is levying another tax by charging those without insurance. They expect police, fire and EMS service to be covered when they pay local taxes. They expect local service - the tax is already paid."

Pam Hopkins, of Annapolis, agreed and said the only upside could be a cutback on the number of what she described as "frivolous calls."

"You can barely pay insurance and the cost of living without having that thrown at you," said Ms. Hopkins, who regularly listens to two scanners in her home. "This is ridiculous. I know some of the calls I hear are absolutely shocking, from somebody's big toe is sore to needing help for an accident from two days ago. And that kind of stuff is unnecessary."

Whether charging for ambulance services would cut down on the number of frivolous calls for emergency transport is still unknown at this time.

"All I can tell you is it brings revenue into the department," said city Fire Chief Jerry Smith. "As a revenue source it would help us."

A public hearing on the bill is expected for the Nov. 27 City Council meeting. Mr. Cordle has also suggested putting together a small committee of city officials to explore the possibility of EMS billing.

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