By Ruth Serven Smith
al.com
People who live in rural parts of Alabama know it may take a long time to get to a doctor.
But before there’s an emergency, they may not also realize how long it takes an ambulance to get to their driveway — and then drive to the nearest hospital.
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“I’ve watched people die while waiting for an ambulance,” said Vicky McCrory, who works for Pickens County Ambulance. “It can take an hour to answer a call.”
Bills in the Alabama legislature are trying to keep local ambulance companies solvent by updating the rates insurance companies pay emergency management services.
“We want to make sure that we have good medical services, and that when you call, you get an ambulance,” said Rep. Bobby Singleton, a sponsor of HB269. “And that the ambulance services get treated right in terms of reimbursements.”
Several Alabama insurers oppose Singleton’s bill, saying carrying more of the costs for services could result in higher premium
“There’s no question that there’s an issue in Alabama,” said Michael O’Malley, with the Alabama Association of Health Plans. “But this would be difficult on those small employers.”
Paramedics speak in favor of the bill
Several paramedics spoke in favor of the bill in a public hearing in Montgomery.
Stephen Wilson, director of operations for Haynes Ambulance in Montgomery, said he frequently has to send Montgomery ambulances down to Lowndes County and other rural areas when their county ambulance is in service. That adds to backups in the city.
He said low reimbursement rates, which the bill is intended to address, add to funding and staffing issues.
“We’re losing EMTS and certified people from the rural areas to the urban areas,” he said. “And we’re losing people from urban areas too.”
The bill and its companion, HB400, also allow EMS services to charge insurance companies for a frequent type of call known as “treat in place,” when a paramedic responds to a scene and offers care on site, but does not transport someone to the hospital.
Sonny Brasfield, with the Alabama Association of County Commissions, said this bill is a priority for rural communities.
“We’re just asking you to take this step to enhance and improve and provide ambulance service at the local level,” he said.
‘Ambulance desert’
Almost all of Alabama is considered to be an “ambulance desert,” according to a 2023 report.
In 2022, Greene County almost lost its single ambulance.
Pickens County, near Tuscaloosa, went down to one ambulance in 2024. Shortly after, people began to die while waiting for care.
Alabama is working on a Rural Health Transformation Initiative and is getting funding, but is also dealing with millions of dollars in federal funding cuts.
Ambulances are far from the only health care service struggling in Alabama’s spiral: Emergency rooms and hospitals are closing. Many pediatricians, dentists and maternity providers have retired or left.
But unlike other services, ambulances are in a unique financial position. If there isn’t a local tax or fee to support them, they must rely on payments from patients or insurance companies.
According to Wilson, the insurance reimbursement rate hasn’t changed for eight years.
Singleton’s bill would only be in effect for three years, through June 1, 2029.
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