Fire billing debate more heat than light


A SMOLDERING dispute over volunteer fire companies billing patients for ambulance service continues to flare.

The Reese fire company reversed itself this month and voted not to bill for its emergency ambulance services. That's after lengthy, arduous debate among Carroll volunteer companies, resulting in an accord that all would bill for ambulance by July 1 this year. (Some have been sending bills to patients for some time.)

Volunteer fire companies will bill all patients, but not dun nonpayers, expecting that private insurance policies and Medicare will pay bills for their insured persons.

Legal issues over tax-exempt status have apparently been resolved. Not entirely resolved is the question of whether volunteer companies that charge for service are still protected by "Good Samaritan" laws from liability.

Meanwhile, the Baltimore County executive is determined to force a state legislative solution down the throat of Carroll County. C. A. Dutch Ruppersberger wants a law that forbids emergency service providers from charging residents of another jurisdiction.

Ruppersberger's principle

Mr. Ruppersberger declares it a matter of principle that fire department ambulances do not charge patients of another county, referring to a 1989 mutual aid agreement between the five metro counties and Baltimore City.

Baltimore County has both volunteer fire stations and paid firefighter stations. Since the taxpayer-funded fire stations can't charge residents, the volunteer companies are also forbidden to do so.

The all-paid fire stations are generally near the Beltway, covering the denser concentration areas of voters who demand municipal services.

But the larger geographical portion of Baltimore County is served by volunteer fire departments and ambulances. They function much as their counterparts in Carroll, with fund-raisers and community suppers and fire hall rentals. And, as in Carroll, the Baltimore County treasury provides the lion's share of the volunteer stations' budget.

But volunteer firefighters still actively solicit community contributions to support the local station. If you don't contribute, goes the line, we can't maintain our quality of emergency service.

Recently, some volunteer stations resorted to a hard sell on the community.

Our own experience

We once called 911 for a medical emergency in Baltimore County. The local fire department ambulance was on another call, so we got the closest backup unit (from another volunteer station).

Within a month, we got a solicitation letter from the backup ambulance station, urging us to recognize financially the importance of that station's services.

The same month, we got the annual door-knock campaign drive from our local volunteer fire station.

There was nothing wrong with the treatment or the response time from the volunteer ambulance crew. They were trained, caring professionals.

The point is that the "principle" of Baltimore County regarding support of volunteer fire companies seems to be flexible.

Flexibility is also what the Carroll volunteer fire companies seek. They simply want to bill recipients of their ambulance service (meeting the law for equal charging) and then wait to see if an insurer pays the bill.

They promise not to force patients to pay. Nearly all fire/ambulance stations are using the same billing service, so there's little chance of uneven application. If Reese doesn't submit a bill to patients, its capabilities and service for all will be little affected. Carroll County is ultimately responsible for maintaining this vital service for residents.

The difference in revenues countywide, however, could be significant. Billings might generate as much as a million dollars a year for emergency services. The county treasury this year allocated $4 million to the 14 Carroll volunteer fire companies, including pay for some medical technicians to cover critical shifts not staffed by volunteers.

It was a wrenching decision, emotionally, philosophically and legally, for the Carroll fire companies to agree to ambulance-billing. It was seen as a necessary step to meet the spiraling cost of staff training and equipment. The volunteer units couldn't bill just Carroll residents and not persons they served in neighboring counties. (Ironically, the billings challenged by Baltimore County government were from the volunteer fire department of Hampstead, part of which lies in Baltimore County.)

There's no suggestion that the mutual aid pact be broken. It could well be amended to restrict billings to patients residing in the county of the volunteer station. For 10 years, Baltimore City has billed its residents but not patients in other counties (but the billing system runs afoul of shared ZIP codes and unusual street borderlines).

One thing is clear: There can be no jurisdictional hesitation when ambulance response is often a matter of life and death.

Mike Burns is The Sun's editorial writer in Carroll County.

Pub Date: 2/28/99

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