Ambulances Should Provide Care First
J. Greene


Q: The other night our family was in a pretty serious car accident. When the ambulance driver got there, he proceeded to tell us how expensive it was to ride in the ambulance ($300 each) and since most health insurance doesn’t pay for ambulances, he would need some money up front. As it turned out, the ambulance personnel did not check us for injuries, and a policeman finally took us to the hospital. Does this sound right to you? How do ambulance services work?

A: It sounds like the entrepreneurial spirit is alive and well in your community’s emergency response system. While it’s possible that your driver was on the up-and-up (local ordinances vary widely on how ambulance services are paid for), the emergency services people we talked to say this sounds quite unusual to them.

      The usual practice is for the ambulance personnel to first take care of anyone who is injured, and then tactfully broach the question of payment and insurance coverage later — the driver might explain that he has to find out the insurance company name for billing at a later time. You told us that this ambulance driver didn't even check you for injuries and you got a ride to the hospital from the police. That doesn't sound right at all. Even though you didn't pay this ambulance company anything, it would be worthwhile to complain to higher-ups to ensure that future consumers get better treatment.
      Because emergency services are provided in so many different ways in different communities, it's hard to say exactly who is responsible for ambulance service where you live. The ambulances and their paramedics or emergency medical technicians (EMTs)could be provided by the local fire department, volunteers, the local hospital, a private local company or a big national firm such as American Medical Response. But one thing they usually share is this: When you call 911, the fire department should send its trained emergency medical people to the scene to treat anyone who's injured. An ambulance is called as well if it turns out anyone needs to be transported to the hospital.
      No matter who provides the ambulance, if it responds to a 911 call, then it's part of the local emergency response system and has some kind of agreement with local authorities to provide certain services. You should check with your city or county's emergency services office, and with the ambulance company, to complain.
      Depending on local laws, ambulances responding to emergencies must be staffed with either paramedics or EMTs, or both. Paramedics are highly trained and are qualified to administer medications such as intravenous lines. EMTs have less intensive training but can respond to a variety of emergency situations. Some ambulances even have critical-care nurses or emergency-room doctors on board to provide the quickest response to serious traumas.
      Maybe one reason the payment question figured so prominently in your situation is that ambulance services are feeling the same pinch from the HMOs that everyone else in medicine is getting. HMOs are cracking down on unnecessary medical transportation. Ambulance companies are complaining that it's gotten so bad that half the time they respond to calls they end up not getting paid. The insurance company may restrict coverage of emergency transport, or the patient may not have insurance coverage.
      Another problem for emergency services is their misuse by people who simply want a ride to the doctor and call 911. While it's true that some insurers will provide transportation for a patient who needs to get to dialysis, for instance, you don't get that service by clogging up the community's emergency response system. Work out nonemergency transit with your hospital or insurance company instead. In fact, most private ambulance runs don't involve emergencies. Instead they're usually moving people from one hospital to another, or between a hospital and a nursing home.
      Still, that doesn't mean you shouldn't call 911 in a real emergency. The hard part for most people is diagnosing themselves well enough to make that decision, says Marijo Rymer, spokeswoman for American Medical Response. "Most of us underestimate our condition, unless it's our kids," she says.
      If your medical plan offers a 24-hour medical-help line, the nurses who staff it should be able to help distinguish between a symptom that can wait for a doctor's appointment the next day or one that needs to be treated right away.
      It's always good to know how your health insurance policy covers ambulance services. But if it turns out you have to pay a $50 deductible — or even the whole bill — don't let that stop you from getting the help you need in a real emergency. At that moment, it's a bargain.

Good Health Return
Good Health Return