Ambulance fee may face bumpy road

Owens hopes to raise $3 million a year by instituting charge

$300 per call predicted

Legal and political concerns complicate such plans elsewhere

May 05, 1999|By Matthew Mosk | Matthew Mosk,SUN STAFF

County Executive Janet S. Owens' proposal to raise money by charging for ambulance services could be a complicated enterprise and, based on experiences in other parts of the state, might not pull in the dollars she is expecting.

Billing insurers each time a resident calls 911 for an ambulance is becoming an increasingly common way for cash-strapped counties and cities to bring in revenue.

Owens offered such a plan Monday as a way to gain about $3 million a year, the first step in paying for her $730 million budget. She called it a harmless fee because only insurance carriers would be billed. If residents couldn't pay, the county would cover the cost. It would be relatively easy to institute, she said.

But such efforts have been complicated elsewhere by, among other things, legal concerns and political disputes. In some cases, local officials said that collecting the fees had proved more difficult than they had expected.

Owens has predicted that the county would charge $300 for each of the 32,000 annual ambulance calls and would collect an average of about $95 per call.

Baltimore charges that amount and collects much less. In 1997, Baltimore collected an average of $27 per call from residents. When the city hired Arizona-based Rural/Metro Ambulance Corp. to bill insurers, that increased to about $30 per call. Dissatisfied, the city decided to resume collections on its own after the company's contract ends.

Rural/Metro, which has contracts with fire departments across the country, defended its results as reasonable and warned other public officials against expecting too much from such programs.

"It's very difficult to have success with those kinds of collections," said Klark Staffan, the company's vice president. "It's a very complex job that involves a high level of expertise. And it doesn't always bring in the kind of money that people are hoping for."

Anne Arundel officials called the comparison with Baltimore unfair because the demographics are different. Andrew C.

Carpenter, the county's spokesman, said there are more insured residents in Anne Arundel than in Baltimore. County officials said they reached their estimates together with fire officials. They provided no details of how those estimates were reached.

Results have also been mixed in Carroll County, where volunteer fire departments recently began charging fees to raise extra money for the cash-strapped ambulance corps.

Sen. Larry E. Haines, a Carroll Republican, said he noticed the shortcomings when his wife slipped on the ice and needed an ambulance. He had insurance, and the company was billed $300, but the ambulance corps got only $125, he said.

"I think there were some miscalculations as to what the actual revenues would be," he said.

Predicting the financial benefits has not been the only difficulty. In several instances, local leaders ran up against liability laws that change when ambulance services are no longer free.

Under the state's Good Samaritan law, paramedics and ambulance crews can not be sued for mistakes they make while responding to emergencies unless they are grossly negligent. That law does not apply when they start charging for services.

In Prince George's County, officials said they opted to pay a nominal amount, less than $100,000, for extra insurance to cover the cost of lawsuits. In Annapolis, concerns about liability derailed plans to charge fees for ambulance service.

"Some jurisdictions have decided to take on that risk, but we didn't think it was worth it," said City Attorney Paul Goetzke.

In Carroll County, the fees sparked a dispute with neighboring Baltimore County when residents in the latter started getting bills for ambulance runs that crossed the county border.

Baltimore County Executive C. A. Dutch Ruppersberger called the fees a violation of mutual aid agreements signed by six counties in the Baltimore area, including Anne Arundel. He also argued that the ambulance fees were essentially a duplicate tax.

"His position was that our residents already pay for that service through their taxes," said Elise Armacost, Ruppersberger's spokeswoman. "He was committed to providing that basic service without billing them for it again."

Anne Arundel officials acknowledged that those issues add complications, but they defended their plan as a sound way to recover some of the substantial costs associated with their fire department's lifesaving medical work.

"We are aware those issues are out there," said Marvin Bond, Owens' chief of staff. "But we don't see them as major problems or as insurmountable. Those are issues that can probably be addressed through regulations."

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