Ambulance services, arguably one of the most critical functions of local government, just got more expensive in Forest Park. And in some cases, a new fee schedule adopted by the village council last month charges double what residents would have otherwise paid for a trip to the emergency room.
The changes are an attempt to capture more revenue from insurance companies, but residents without insurance – or whose insurance only covers a portion of the cost – would be asked to pay. Forest Park has a longstanding practice of forgiving residents asked to pay out-of-pocket for ambulance services, and generally won’t drag the matter into court.
But not everyone who gets a bill is likely to know this, and local ordinances make no mention of how ambulance fees will – or won’t – be collected.
“Let’s have it documented,” said Commissioner Marty Tellalian, who voted against increasing the fees. “Let’s have a policy that clearly states what qualifies someone for a discount.”
According to figures obtained from the village through a public records request, Forest Park receives about half of what is billed to residents who require an ambulance. In 2007, a total of $211,871 was charged. More than 35 percent of that figure, or $76,000, was written off. Another $21,290 in discounts went uncollected, according to the village.
In 2008, the billing figures were similar. A little more than $250,300 was charged and only $130,700 was collected.
Finance Director Judy Kovacs said that the billing company hired by the village is the contact for residents with a concern about an invoice. Paramedic Services of Illinois decides when to write-off an unpaid expense and when to offer a discounted price. That decision is “based on need,” said Kovacs, but is subjective.
She said the village has no idea how many such calls the company receives, nor is there a record of who receives a break on paramedic services. Residents may not be aware that there are no repercussions for ignoring the bill, said Kovacs.
“Some people might just go ahead and send that [outstanding balance] in,” Kovacs said. “We’ll take it.”
An employee for Paramedic Services of Illinois said all inquiries related to their service are to be directed to the municipality.
Mayor Anthony Calderone said he was not certain, but believed residents are rarely, if ever, billed for ambulance services. The mayor indicated he was not aware that the unpaid portion of an ambulance fee is billed to residents.
“I think it’s rare that somebody who uses an ambulance in Forest Park does not have insurance,” Calderone said.
During the village council’s April discussion of the fee increase, officials were reluctant to discuss the fact that residents aren’t typically forced to pay bills related to the emergency service. The municipality is trying to remain sensitive to people’s ability to pay while, at the same time, making an effort to cover costs.
Ambulance users who do not live in Forest Park have historically been charged more for the same service, though the recently adopted fee schedule applies the same rates for all users. Neighboring communities have adopted a similar position, and justify charging residents a reduced rate because their taxes already supplement government services. Payment from nonresidents is pursued more aggressively, officials indicated.
“It’s not unusual,” Mike Durkin, village attorney, said of Forest Park’s billing practices. “The need to collect revenue from nonresidents isn’t tempered by the same need to provide a service to a resident.”
But with no apparent effort to inform residents that they don’t have to pony up after being rushed to an emergency room, those who pay the bill could feel cheated if their neighbor incurs no penalty for ignoring an invoice.
“I don’t think anybody will begrudge a neighbor in need,” Kovacs said.
Fire Chief Steve Glinke said his office is responsible for sending insurance and billing information to the third-party vendor. His department is not responsible for how the bills are ultimately handled, and Glinke said he’s unsure whether residents negotiate discounts with the paramedic company or with Forest Park’s finance department. Annually, said Glinke, he receives about a half-dozen calls from residents seeking relief from charges related to paramedic services.
Commissioner Rory Hoskins, who oversees both the finance and fire departments, said he did not know whether discounts are arranged by village staff or Paramedic Services of Illinois. Hoskins said he is interested in reviewing the municipality’s billing policies.
A financial arm of Medicare and Medicaid sets a maximum reimbursement rate that service providers must accept as full payment, regardless of the fees they might charge. Many communities use these rates as a cap, which had been the practice in Forest Park.
Philosophically, Glinke said he disagrees with the council’s decision to increase the fees, but it’s not his decision to make. By law, said Glinke, the village must make an effort to collect any unpaid portion of the fee, but Forest Park isn’t obligated to charge $1,000 for life support services and $25 per mile.
“That’s more a decision for the policy makers,” Glinke said. “It’s simply not my decision to make.”
Medicare’s 2009 fee schedule pays $621 for the same life support service for which Forest Park will bill $1,000. Mileage reimbursement is capped at $6.87.
In nearby Brookfield, an ordinance adopted in 2003 sets ambulance fees at a much lower rate than in Forest Park, and clearly states the collections process. Residents without insurance won’t receive a bill. If insurance information can’t be obtained by paramedics on the scene, or the hospital, Brookfield’s paramedic service will later solicit that information from the patient. If there’s no response, the billing company sends the resident an invoice, which is followed by another invoice 30 days later. That is where the effort to collect ends.
Brookfield Fire Chief Pat Lendi acknowledged that though the ordinance is a matter of public record, it is not the subject of a public awareness campaign.
“There are occasional inquiries when they get a bill, and after it’s explained, they’re generally pretty satisfied with how it works,” Lendi said.
Commissioner Mike Curry moved to increase Forest Park’s ambulance fees based on an e-mail sent to the village from Paramedic Services of Illinois. He described the rates as “reasonable and customary,” but acknowledged basing that opinion on information provided by the billing company. Paramedic Services of Illinois receives a percentage of what it collects on behalf of the village.
Adopting a policy similar to Brookfield’s, said Curry, could give insurance companies leverage in arguing they are no more responsible for paying for paramedic services than residents.
Durkin, the village’s attorney, agreed that such an argument could be made.
Curry acknowledged the collections process may not be equitable.
“I understand the dilemma. You have one neighbor that says, ‘You didn’t know?’ and you have one neighbor that says, ‘No, I paid the whole thing,’ ” Curry said.