Ambulance billing seen as a solution Fire companies to ask insurance to pay for service; Shortage of volunteers; System would allow departments to hire full-time paramedics


Billing insurers for ambulance calls would help Carroll's volunteer fire departments employ full-time paramedics, but might deter volunteerism and enrich the busiest companies, according to fire officials.

At its annual convention this month, the Carroll County Volunteer Firemen's Association voted to end what has been a free ride for emergency patients and to support billing at all its 14 companies.

"What do you do to provide appropriate coverage and how do you offset the expense?" asked Bob Cumberland, an officer in the association and the Westminster company. "You go with 24 hours, seven days, and you pay for it by billing. You can't ask a volunteer to work two calls in the middle of the night and then go to work the next day."

A $10,000 consultant's study, for which the association paid, recommends 24-hour, seven-day coverage at four high-volume stations in Carroll: Westminster, Sykesville, Manchester and Taneytown, and emergency personnel at the other fire departments. No company expects to fill those slots with volunteers.

"Since the county does not want to provide the dollars, we have to find alternate ways to fund emergency services," said Libby Luebberman, emergency services captain at Sykesville, which handled about 1,500 ambulance calls last year.

The county funds 90 percent of the fire companies' operating budgets -- more than $4.1 million for fiscal 1999, which begins July 1. About $550,000 of the budget goes to Emergency Medical Services (EMS), but it would take at least another $500,000 to pay for the paramedic positions recommended in the study.

Commissioner W. Benjamin Brown called billing "a commitment to meeting the increasing medical services needs of our growing county." That commitment, he said, does not rely on taxpayers.

Paid EMS system

"Maybe it is time Carroll County goes to a fully paid EMS system with a director and full-time employees," said Dennis Beard, a past association president and now treasurer at Sykesville.

If that occurs, it could mean an end to EMS volunteers, Luebberman said. Federal labor laws prohibit Sykesville or any other company from having paid employees function as volunteers, although those qualified can work at other companies in the county or in neighboring areas. Luebberman ** volunteers at Sykesville and works at Westminster.

"We can't pay people that volunteer at our station to work there," said Luebberman. "This could drive interested volunteers away."

But billing may be the only way to pay for continuous coverage. When Sykesville, second only to Westminster in volume of calls, sent letters soliciting donations to 1,000 of those it transported last year, the response was about $23,000. Charging insurers $300 per call could have meant as much as $450,000. Numbers like that could put companies into the profit column, but Luebberman does not envision overflowing coffers.

"The dollars are out there, but we don't know how much," she said. "We have many uninsured and needy who will not reimburse us. Insurers may not pay for every call either, especially if they decide it is not a true emergency transport."

Competitive salaries

The fire companies will have to pay competitive salaries to attract and keep paramedics; fund costly and time-consuming training programs and procure $100,000 ambulances -- several stations have two -- that have to be replaced about every four years.

An enormous increase in the volume of calls and declining numbers of volunteers have made billing necessary. The numerous blanks on the volunteer sign-in board at Reese Volunteer Fire Company on Route 140 are one example of the countywide problem.

Bob Alexander, the newly elected association president and a longtime Reese volunteer, knows volunteers alone can't fill in the gaps and ensure a timely response to the 1,000 calls Reese gets every year.

"Summer gives us some of our worst coverage problems," Alexander said. "People want to spend weekends doing family things and we are getting more ambulance calls than ever."

Westminster, which handled more than 3,600 fire and emergency calls last year, began billing insurance companies in January 1997. Union Bridge, Winfield and Pleasant Valley followed suit.

"We looked long and hard at this, but we all know volunteer schedules don't allow us to give full coverage 24 hours a day," said Cumberland.

Billing resistance fades

Many other companies, particularly Sykesville, have strenuously resisted billing, but now support the practice. By summer's end, all 14 companies are expected to be charging insurers for ambulance service to area hospitals.

The companies will be individually responsible for billing and collecting fees, with the association overseeing the effort and working for uniformity of charges. The association would prefer that one billing consultant handle the service for all the companies.

"We are all trying to provide Carroll County with the best service, but we don't have the troops to do it," Beard said. "We have a serious problem here. Nobody has enough volunteers."

If the association educates the public on the necessity of billing, residents will continue to support the carnivals, bingo and other events that raise money for the companies, the study said. The consultants reviewed other counties served by volunteer firefighters and found little change in contributions once billing began.

"Billing is just a reality we all have to face," said Beard. "I don't think contributions will go down. The way it is now, taxpayers are footing 100 percent of the bill."

Pub Date: 5/31/98

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