Trending Topics

Wash. city council approves ambulance transportation fees

Chehalis legislators approved BLS, ALS levels of fees to offset inflation, increased costs


Photo/Getty Images

By Owen Sexton
The Chronicle

CHEHALIS, Wash. — During Monday’s Chehalis City Council meeting, councilors unanimously approved an ordinance on its first reading creating a new chapter in the city’s municipal code that institutes fees for ambulance rides.

The ordinance also authorizes city staff to work on entering into a contract with a third-party billing company to handle billing and collections. Prior to the vote, ambulance services were provided at zero or minimal cost.

Chehalis Fire Chief Adam Fulbright told the council that given the city’s current growth, it is no longer recovering costs associated with ambulance transportation. The city can’t afford to keep absorbing those costs as calls for emergency medical services increase, he added.

Along with the city’s growth, inflation is hitting the fire department’s budget with increases to costs of medical supplies and fuel.

“It’s becoming a bit of a burden on the general funds and also the taxpayers,” Fulbright said.

The fee’s rate structure is broken up into two categories, Chehalis residents and non-residents, with three sections of service depending on the level of life support someone needs.

“Residents reside in the city, they pay into the general fund through a tax,” Fulbright said. “They also pay into an EMS (emergency medical services) levy, which provides the availability of the service, and so those who reside in the city limits, they have a lower transport rate.”

A basic life support (BLS) ambulance transport will cost $975 for residents and $1,075 for non-residents.

An advanced life support (ALS) ambulance transport, level 1-E, will cost $1,275 for residents and $1,375 for non-residents.

An ALS ambulance transport, level 2, will cost $1,475 for residents and $1,575 for non-residents.

Additionally, a fee of $20 per mile of transportation will be charged for each ride. The ordinance as approved includes an annual 3% fee increase in January of each year, according to the city council’s agenda report.

Assuming those needing ambulance transport have insurance, the insurance companies will be billed for 80% of the transportation’s fee, with non-residents being billed for the remaining 20% and residents having the remaining 20% waived, Fulbright added.

Those who do not have health insurance will receive a bill for the full cost of transportation.

While the Chehalis Fire Department only provided BLS ambulance services in the past, Fulbright got the council’s approval to transition the department to provide ALS services during the previous city council meeting earlier in August.

ALS services include a wide scope of medical care options to drastically improve survival chances for patients suffering from life-threatening illnesses or injuries, including heart attacks, strokes, respiratory conditions, diabetic emergencies and more than 200 other life-threatening medical emergencies.

As for the third-party company the city will contract with for billing, the company will be System Design West, LLC — a Poulsbo-based EMS billing agency that will handle sending invoices and collections for ambulance transportation fees.

System Design West provides billing services to EMS and fire departments throughout the western U.S. and works with patients’ insurance agencies, according to its website. The agenda report stated Lewis County fire districts in Morton, Chehalis, Adna, Winlock and the Riverside Fire Authority in Centralia also utilize the company’s services.

The city will pay a one-time fee of $750 to use System Design West’s services, then be billed at $35 per ambulance transport for up to 10 transports in a month or quarter, $30 per transport for 11 to 20 transports in a month or quarter and $25 per transport for 21 or more transports in a month or quarter.

“We’re finding ourselves, over the last couple of years, averaging 40 to 60 transports a year,” Fulbright said.

American Medical Response (AMR) ambulances usually handle patient transport in Chehalis when required, but the Chehalis Fire Department steps in to transport patients in its own ambulance when AMR has no available units to respond, Fulbright said.

With the new billing system, the city would pay a total of $2,850 the first year, assuming a total of 60 patients need rides and cost the city $35 per ambulance ride, plus the one-time $750 fee.

According to the agenda report, this cost will be offset by estimated revenue of $46,800, which is 80% of $58,500, assuming all 60 patients are Chehalis residents only needing BLS services — costing $975 a ride — and have insurance, which pays 80% of the billed cost.

While the ordinance was passed unanimously, the councilors did have some questions. Councilor Bob Spahr wondered if the discount for Chehalis residents should be larger.

“For EMS, $0.50 (per $1,000 assessed property value) on a $300,000 house is $150, pay that for 10 years and you’ve got some money invested,” Spahr said. “Is $100 enough of a discount?”

As long as a resident has insurance, the insurance company will pay 80% and the remaining 20% will be waived, Fulbright said. Fulbright added he believes $100 was enough of a discount.

The ordinance establishing ambulance transportation fees will receive its second and final reading at the Sept. 11 Chehalis City Council meeting.

To read the ordinance, go to page 57 of the Chehalis City Council agenda report at

(c)2023 The Chronicle (Centralia, Wash.)
Visit The Chronicle (Centralia, Wash.) at
Distributed by Tribune Content Agency, LLC.