During the meeting Tuesday, the council was presented with two options that would charge for paramedic care provided by the Monterey Fire Department to Monterey residents on emergency medical calls where an ambulance transport is needed. Patients who receive treatment but decline transport would not be charged.
Assistant Fire Chief Pat Moore said the proposed $327 fee is based on the cost of a three-person fire crew responding to a medical call, average on-scene time, emergency medical supplies and a 16% administrative fee. Billing would be handled by a third-party agency on a per-incident basis, meaning the city would pay for the service regardless of whether the fee is ultimately collected.
Under option one, the city would bill insurance companies only. Moore said staff determined that approach is not viable because most insurers do not pay for first responder medical treatment. He said United, Blue Cross and Aetna do not cover the fee, Medi-Cal does not pay for it, and there is no standard industry billing code for paramedic treatment separate from ambulance transport. However, Kaiser, an HMO-based provider, is the only insurance known to pay the fee, largely because it prioritizes on-scene care over hospital transport.
Option two would bill insurance first and then bill the patient if insurance does not pay. Staff said this option would result in a significantly higher rate of return, estimated at about 42% after paying the billing company, generating more than $500,000 annually.
If implemented, firefighters would be required to collect patient information during medical calls. Moore said exemptions and hardship waivers could be created, but doing so would require the city to develop standards, verify financial information, track records and store documentation. He said some fire departments that use patient billing have struggled with being overwhelmed by paperwork and verification requirements.
The council gave mixed reviews. Councilwoman Kim Barber said she would not be supporting the proposal, saying that both options were going to be a burden on the patient.
“It’s very obvious to a lot of people that healthcare is on the rise, this is adding stress to people,” Barber said. “I think there are other ways to get there. We’re already looking at taxes that are a burden to residents.”
Councilman Gino Garcia said he was worried people would hesitate to call 911.
“I don’t want people to debate calling (emergency services) because it might affect their financial situation,” Garcia said.
Meanwhile Mayor Tyller Williamson said he would like to see more information about option 1, and Councilwoman Jean Rasch said cost-saving measures could be explored in the future.
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