Baltimore County FD to start charging for ambulance transport
The plan to bill a fee plus mileage to insurance, Medicaid or Medicare could raise $26M per year
By Pamela Wood
The Baltimore Sun
BALTIMORE — Baltimore County plans to begin charging fees for ambulance rides — reversing a policy that for years has set the county apart from nearly every other jurisdiction in Maryland and many across the country.
The fees, $700 or $750, depending on the type of care provided, plus $10 per mile, will be charged to a patient's health insurance company, Medicaid or Medicare.
The plan, announced Monday, is expected to add up to $26 million annually to county coffers.
Officials say every other jurisdiction in Maryland except Calvert County currently charges some fee for ambulance services. Howard County does not charge a specific ambulance fee but has a separate tax for fire department and rescue services.
Baltimore City has charged for ambulance rides since 1989.
"Across the country, it's become a standard and accepted procedure for fire departments to seek reimbursement from insurers and from Medicare and Medicaid," said Elise Armacost, a county Fire Department spokeswoman.
"We were out of step with just about everybody else on this issue," she said.
Baltimore County's fire service includes career and volunteer stations. In recent years, the Baltimore County Volunteer Firemen's Association has advocated changing the ambulance policy, arguing that the county was turning away millions in revenue from insurance payouts by not charging a fee. Ambulance service costs are now paid through the county's general fund.
Armacost said county officials still believe emergency medical care is a fundamental service to taxpayers. Patients who live in the county but who don't have insurance — or whose insurance companies refuse to pay — will not be charged, officials said. Bills will be sent directly to insurance companies after a patient has been treated.
"No county resident will pay one penny out of his or her own pocket for ambulance service," county fire Chief John J. Hohman said in a statement Monday.
Noncounty residents, however, will be billed if their insurance doesn't cover the ambulance fee.
In a statement, County Executive Kevin Kamenetz said with more people having insurance because of the federal Affordable Care Act — and more insurance companies willing to pay the ambulance fees directly — it makes sense for the county to begin billing insurance companies.
"It is only fair to our citizens and our EMS providers that we bring ourselves in line with this now accepted practice and try to recoup some of these transport costs from insurers," Kamenetz said in a statement.
Neither Hohman nor Kamenetz were available Monday for additional comment.
Baltimore County Councilman Julian Jones — a Woodstock Democrat who is a division chief in Anne Arundel County's Fire Department — said he was initially opposed to ambulance fees but has changed his mind as he's seen county after county adopt them.
In Anne Arundel, for example, fees were raised last year from $500 to $700 and $750.
"When these first started, I was against it. I thought taxpayer dollars paid for the services," Jones said. "I didn't want people afraid to call 911."
But he said the fees are more palatable because insurance companies usually pay them and because most counties engage in "soft billing" — not pursuing collection from people who can't pay.
"Everybody around us is collecting these fees, so now it becomes a thing of Baltimore County leaving somewhere around $26 million on the table," Jones said.
Jones said insurance companies already factor in ambulance fees when calculating rates because most jurisdictions charge them, and he doesn't expect residents' insurance premiums to go up because of the policy change.
He said he wouldn't support the proposal if he "thought for one minute that insurance companies would raise their rates."
The County Council must approve the two-year contract with a vendor that will process the payments, in exchange for 4 percent to 4.75 percent of the money collected. Council members will discuss the contract at a July 28 work session, with a vote scheduled for Aug. 3. The fees are scheduled to go into effect Sept. 1.
The county responds to about 85,000 calls requiring ambulance service each year, according to county officials.
Money collected from fees will go into the county's general fund, with some directed to volunteer fire companies to help pay for the cost of providing emergency medical and ambulance service. Details have not been worked out, Armacost said.
A report issued in a December by a consultant hired by the volunteer firemen's association suggested that charging ambulance fees could raise more than $35 million based on a $1,000 fee collected from two-thirds of all ambulance trips.
John McDowell, president of the volunteer fireman's association, said he was "pleasantly surprised" when he learned a few weeks ago the county decided to charge the fees, and is glad volunteer stations will get at least some of the money.
"It goes a long way to helping the volunteers put more medics on the street," he said.
The report also described financial and staffing issues at several volunteer stations, and suggested closing some stations and merging others.
Baltimore Sun researcher Paul McCardell contributed to this article.
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