Officials aim to add charge for ambulance Bill would allow fees for emergency service


The city of Annapolis sees money in your medical emergency.

Local officials are pushing a plan that would allow the city to collect an estimated $100,000 a year from insurance companies to pay for emergency medical care for everyone from car crash victims to cardiac arrest patients.

The plan, which would end what has been a free service in Annapolis, faces its first test this week when state legislators consider changes that would allow local governments to collect such fees without the threat of lawsuits.

City attorney Paul G. Goetzke looks at the proposal as an innovative way to collect money for the city coffers by billing insurance companies he says enjoy a "windfall" of cash at taxpayer expense.

"This is part of a growing trend among governments to look for alternative sources of revenues without imposing taxes or fees," Mr. Goetzke said. "We have no interest in collecting from the patient. We're only interested in receiving payment from the existing insurance companies."

But health insurance providers warn if the proposal is approved, higher insurance rates are likely, even for Annapolis residents who go years without dialing 911.

"We don't have pots of money just sitting around," said Dr. Robert Rosenberg, chief medical officer with Blue Cross and Blue Shield of Maryland. "We would have to increase the premiums. Somebody's got to pay for all this."

Meanwhile, some emergency medical service experts warn the service is far too costly to fall on insurers without some fallout at public expense.

"Where does the city think the money is going to come from? It comes from you, the consumer," said Jack Stout, a consultant who has been advising the county as it seeks to revamp its emergency medical services. "This is a good deal more complicated than all these people are assuming."

The city pays for its roughly 5,000 ambulance trips a year from its general fund, at a cost of roughly $235 per patient. But the costs are likely to increase as ambulance assistance becomes more sophisticated, federal regulations are tightened and demands are placed on emergency services.

Under the city's plan, bills would go to private insurers or Medicare. People without insurance would continue to get the emergency medical service free.

The city Fire Department, which runs the emergency medical service, has suggested charging $100 or $150 per emergency medical service visit, even though the department figures the calls cost an average of $235. Some private ambulance companies charge up to $500 per call.

The service consumes $1.1 million of the department's $4.7 million budget while calls for ambulances and emergency medical service make up roughly 70 percent of the department's work.

"We're starting to realize, hey, we're really providing health care here," said Capt. Dale A. Crutchley, who heads the department's emergency medical services program and was the first to urge the city to charge for ambulance visits. "I think it's reasonable to bill for our service."

The proposed change in state law has won early endorsements by the Maryland Association of Counties and the Maryland Municipal League. If it is approved, it would go into effect in October. The Annapolis city council would have to establish a plan with specific billing guidelines.

The House Judiciary Committee will hold a hearing Thursday on a proposed amendment to the state's Good Samaritan Immunity law that would allow fire, emergency, rescue, ambulance and law enforcement agencies to charge fees for their services without facing potential lawsuits.

The state attorney general's office ruled last year that such fees would jeopardize the protection from laws that otherwise exempt emergency medical service providers from lawsuits by victims.

Baltimore and a few counties already charge for ambulance services, but they usually hide the charge in nonmedical fees -- such as transportation costs -- to avoid lawsuits, Mr. Goetzke said. Legal experts say those governments are vulnerable to penalties if a patient decides to sue for reasons unrelated to the fees.

The chairman of the Anne Arundel County delegation, Del. Phillip D. Bissett, an Edgewater Republican, is steering the bill through the legislature at the behest of Mr. Goetzke. Like the city attorney, Mr. Bissett sees the change in billing as a potential revenue source for cities and counties.

"I think in the days of tightening budgets, this might be just a simple matter of survival," Mr. Bissett said.

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