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One Volunteer’s Thoughts on Ambulance Billing

One Volunteer’s Thoughts on Ambulance Billing

By Geoffrey Burns

So, the great debate in Montgomery County fire houses, the internet, and just about everywhere else you look is the debate over the implementation of an EMS Transport Fee.

Let’s look at the pros of this initiative:

1)    $14 Million in revenue for the fire/rescue service (actually about $12M after costs for running the program).

2)    More manpower on the rigs on the street.

3)    People don’t lose jobs.

4)    People don’t lose money through furloughs and layoffs.

5)    More equipment to do the job.

Let’s look at the cons of this initiative:


See my point? Have you read Bill 13-10 yourself? If not, please do so. If you search on Google for Montgomery County, MD Bill 13-10 you will find it.

The ONLY thing this is doing is causing a rift between career and volunteer firefighters. I can’t blame the career staff, I would be pissed off too.

This is screwing with their livelihood, their ability to pay their bills, and their quality of life in general.

And not only that, but the fee would benefit the volunteers as well by being able to provide equipment, gear, and tools we should already have to fight fires. So it doesn’t just affect the career staff, but the fire service in Montgomery County AS A WHOLE!

Now, for those of you who would say ‘Well, aren’t you a volunteer with a car and free gas, etc.?’, to answer you, I will say ‘No, I’m not.’ I have a chief’s vehicle, yes, but I made an agreement with my corporation that I would not use any tax funds for the vehicle, that I would pay for all the gas, maintenance, tires, and equipment for the vehicle. I was fortunate to have a friend in the business who helped me out a great deal in getting items for the car either at cost, or demo items that were being discontinued. Any time anything goes wrong with that car, I pay to fix it out of my own pocket. Anytime I need gas, I pay for it out of my own pocket.

Yes, I get a ‘stipend’ check from the county for $300 every July. You know what? Take it back, use it for something else. It’s not something I asked for, or expect, or couldn’t do without.

I heard this on Opie and Anthony this week as they were talking about Cyberbullying and Perez Hilton. Just like not all gay like Perez Hilton or subscribe to his views, not all volunteers in Montgomery County are in favor of blocking this fee or like the people who support blocking it.

I’m sure I’m not the only volunteer in the county who feels this way either.

I was not in favor and voted at my LFRD against supporting the financial end of fighting the fees. I know there were others, and complete corporations who refused to donate to the fund.

The facts are this: The fee is already being collected by many insurance companies. Get the money back to MCFRS where it belongs.

Let’s stop the stupid stuff and remember why we are (or why we are supposed to be) here doing what we do.

Ambulance Reimbursement from a Dissenting Volunteer Paramedic’s perspective

Ambulance Reimbursement from a Dissenting Volunteer Paramedic’s perspective

I am Pamela Boe, and I am a paramedic associated with the Upper Montgomery County Volunteer Fire Department, who wishes to clarify some misinformation being spread about Question A, the Ambulance Reimbursement ballot measure.

The Montgomery County Volunteer Fire and Rescue Association (MCVFRA) did, in fact, vote to fight the implementation of the law that allows the County to seek reimbursement from insurance companies, Medicare and Medicaid for ambulance transports, but that decision by the MCVFRA won only by a slight margin. As it is, many of the volunteers I work with do not agree with the Association’s stance against ambulance billing, yet we have no voice within that Association as individuals. We have watched helplessly as the Volunteer Association has manufactured facts, misquoted figures, manipulated words and spread fear among the general populace about future fees, hard billing, or where the money is going. Eric Bernard, the Executive Director of the Volunteer Association, has been divisive on so many issues it is hard to pick just one, but for the record, he does NOT speak for all of the Fire and Rescue Volunteers within Montgomery County. Personally, I am disgusted with the way he has repeatedly antagonized and polarized a system that should work very closely and smoothly together.

A primary reason the Volunteer Association does not wish to see this pass is because they fear it would result in fewer donations to the individual Volunteer Fire Departments by the community. They fear the community would think, “Why would I donate when the insurance company is already paying?” The answer is that the insurance company won’t pay for all of it. Furthermore, dear taxpayer, you are already paying for it in both your insurance AND your taxes. How does that make sense??

If this law gets repealed, and the ambulance reimbursement requests do not go to insurance companies, there are going to be fewer ambulances and medic units available. The loss of $14 million dollars in an already VERY tight budget will result in the loss of career firefighters and therefore the loss of emergency services. The volunteers will not be able to pick up the slack. Eric Bernard and the Volunteer Association quote large, impressive numbers of volunteers every time I turn around. The truth of the matter is, even IF those numbers were correct, (and personally, I highly doubt their veracity), those numbers do NOT reflect the actual number of active EMS and fire providers able to staff units, or who are currently on the IECS (Integrated Emergency Command Structure) list as certified providers. In other words, folks, we NEED that money.

I am not a registered Republican, but I DO believe in smaller government, and I would rather see any money that is reimbursed by the insurance companies returned to the tax payers. It is a shame that the vote didn’t go that direction when the issue of reimbursement originally came up. But, the law was passed, and the resulting income was counted on in this year’s budget. The horses are already out of the barn. Returning them would cost the county $14 Million. That means it would cost YOU AND ME $14 Million, either in the form of money or services. It has got to come from somewhere…its either going to come from a tax hike, new County-imposed fees elsewhere, or cuts in services.

Understand this: If you vote “no” on the Ambulance reimbursement, it will translate to you, the county taxpayer, as longer response times during an emergency because there will be fewer units and fewer personnel out there to respond — OR it will translate to you in the form of higher taxes and fees — OR BOTH. Every Department in the county could be effected…attorney’s office, snow removal, human services, anything the county budgets for will be at risk in this cut.

I am voting YES on Question A to keep the law that allows reimbursement for County ambulance services, and I am a County Volunteer Medic, and I see first-hand why this county needs it.

Pamela Boe

As the ambulance rolls, insurance pays the tolls

As the ambulance rolls, insurance pays the tolls

Silver Chips Online

Ambulance reimbursement fees are a wise way to raise revenue for emergency response

By Maureen Lei, Page Editor
October 7, 2010

When a fuse box explodes and sets a home on fire, a senior citizen has a stroke or an office building collapses, a hero must come to the rescue. This hero is the fire department.


Fire departments provide services that make daily life safer and provide care in the case of emergencies. In a society without properly funded and functioning fire departments, chaos will ensue. If fire departments are unable to obtain easily accessible funds, like ambulance reimbursement fees, service will suffer.

According to Neil Greenberger, spokesman for the Montgomery County Council, the Montgomery County Fire and Rescue Service (MCFRS) Fiscal Year (FY) 2011 budget includes an ambulance reimbursement fee. It is a $300 to $800 base charge, depending on the severity of the situation, plus $8.15 per mile traveled by the ambulance.

Ever since the fee was instated this summer, its opponents and supporters have clashed. Some claim that it puts financial and medical burdens on citizens, but others feel it is a reasonable way to help the shrinking MCFRS budget.

According to Patrick Lacefield, spokesman for Montgomery County Executive Ike Leggett (D), neither insurance holders nor citizens without insurance pay the fee. If a county resident with insurance takes an ambulance, the county bills the insurance company, and the resident is not responsible for deductibles, co-pay or any other form of payment. He or she pays nothing. If a county resident without insurance takes an ambulance, the county bills no one. He or she pays nothing.

Lacefield described the reimbursement fee as a means of tapping into an idling resource. Residents pay their insurance companies premiums, and a portion of this money is designed to pay for ambulance services. However, the county has not collected it in the past.

Even though the reimbursement fee will not affect county citizens, it is predicted to bring the MCFRS $14 million this year, and $170 million over the next 10 years, including this year. The FY 2011 budget includes the projected $14 million, said Greenberger. With the MCFRS budget already reduced from $193 million in FY 2010 to $182 million in FY 2011, it makes little sense not to utilize this opportunity – especially since the money does not come from the pockets of county residents.

The $14 million of revenue is needed now more than ever. The budget suffered a six percent decrease from that of FY 2010. This cut would not have been made if there were enough funds to go around in the county. It is an indication that the county cannot fill expenditures the way it has in previous years. To turn down any source of revenue, then, is an imprudent choice to make.

The $14 million in reimbursement fees would ensure that the MCFRS could continue to guarantee world-class care in the case of an emergency. Without reimbursement fees, the MCFRS would struggle to pay for the equipment, facilities and staff necessary to do so.

Even so, some argue against the fees. The Montgomery County Volunteer Fire and Rescue Association (MCVFRA), a distinct entity from the MCFRS, recently had its petition against the fee rejected by the Montgomery County Board of Elections. Eric Bernard, executive director of the MCVFRA, said that similar fees in other local jurisdictions have been shown to deter those in medical emergencies from calling 911.

He failed to acknowledge that statistics regarding 911 calls show mixed results. There are enough instances of rates staying consistent and even rising after fee enactments to invalidate his argument. In some jurisdictions, such as Fairfax County and Prince George’s County, rates increased after enactment. In others, they may have decreased, but there is not a strong enough trend to support Bernard’s conclusion.

Bernard also said that the only county residents without insurance who do not pay the fee are those of low economic status. “[Residents without insurance] don’t pay only if they meet the poverty level and send in tax records and personal bank records,” he said. Again, his statement is false. There is no established poverty level to meet, and there is no requirement to submit financial records. Those without insurance simply do not pay.

Opposition to ambulance reimbursement fees is fueled by one thing: misinformation.

The MCVFRA’s arguments against the fees seem to make a good case, but they are completely unfounded. In reality, the fees bring much-needed revenue into a tight budget at no cost to the people they are meant to serve.