ALBANY — New Yorkers cared for in an emergency by an ambulance crew from their local tax-funded volunteer fire department could be hit with a "surprise bill" of $1,000 or more, which would be partly paid through health insurance, under a hotly contested bill in Albany.
The measure would allow volunteer fire departments funded by taxes or through municipal contracts to also charge individuals for ambulance services and emergency medical services. It passed the State Senate, 61-2, on Monday and now goes to the Assembly.
Similar bills have been pushed in past years by local volunteer fire departments, which often have great political influence in suburban and rural legislative districts. But those bills have stalled under intense lobbying by private sector ambulance services.
Private sector ambulance services, ambulances that are part of police departments, usually in cities, and volunteer ambulance corps may already charge fees for service under state law. Part of the cost is paid by the patients’ health insurance. But ambulances that are part of volunteer fire departments now can’t charge a fee under state law because the departments are taxpayer funded.
"The volunteers and fire service across the whole state have stepped forward to serve their communities and never asked for anything," said Sen. John Brooks (D-Seaford), the Senate sponsor. "The volume and cost of this service has increased dramatically, and insurance provides for this … it’s better than charging taxpayers when insurance has the service."
But private sector ambulances say that would give volunteer fire departments an extra source of revenue in addition to the tax dollars they already receive and create an advantage that the private ambulance services can’t match.
New Yorkers who call 911 for an ambulance get whatever crew is closest and qualified as determined by the emergency dispatcher. If a private ambulance is dispatched, patients are often surprised when they receive a bill from the ambulance company. Some people, however, directly call their volunteer fire department knowing they won’t be charged a fee, which Brooks said is one reason why the volume of calls has increased for those departments.
Brooks and the Assembly sponsor, Assemb. Billy Jones (D-Chateaugay Lake), said they didn’t have an estimate or range that New Yorkers would have to pay to the volunteer fire departments. They said that would depend on the level of service provided and the insurance policy of the person who uses the ambulance. New Yorkers without insurance or government-subsidized health coverage, such as Medicaid or Medicare, wouldn’t be charged, according to the bill.
Fair Health, a national, independent nonprofit research entity, said the charge for an ambulance trip for "advanced life support" rose 22.6% nationally to $1,277 in 2020 compared to 2017. The charge for less intensive "basic life support" increased 17.5% during the same period to $940 in 2020, according to Fair Health.
Additional fees for mileage to a hospital and for services such as oxygen also can be charged.
Brooks and Jones call the measure "cost recovery." They say volunteer fire departments need the revenue to pay for the rising cost of equipment, the rising volume of calls as populations age, the lengthy trips for rural services that was worsened by frequent transport of COVID-19 patients, and potentially to pay first responders as the number of volunteers continues to dwindle.
"This is a chance to go to the insurance industry," Brooks said in an interview with Newsday. As for the remainder of the cost to be paid out of pocket, he said: "It’s not going to be an outrageous fee."
The fees collected would go the volunteer fire departments for equipment, material, wages and costs other than the ambulance service, Brooks and Jones said.
The United New York Ambulance Network, based upstate in Cortland, is continuing to lobby against the measure, said organization chairman Jeff Call. He said the organization representing private sector ambulance services understands the opportunity for volunteer fire departments to collect insurance payments for coverage already offered, but is concerned that volunteer fire departments that are "100% tax supported" would get insurance money as an extra source of revenue. That would put private ambulance at a competitive disadvantage.
"The statewide commercial ambulance industry has provided communities with comprehensive access to EMS services across New York State, including the most vulnerable of populations — seniors and the disabled," Call told Newsday. The measure "fails to recognize the high level of care provided by non-fire EMS, especially to those in at-risk situations. Without this benefit, patients and taxpayers will have to once again foot a bill for volunteer fire districts that are already financially supported by residents … we should all play by the same rules."
The most intense lobbying has been in the Assembly, where the bill could be moved to the floor in coming weeks, or languish in committee for another year. A new version of the bill was agreed to by the Senate and Assembly sponsors in Februrary.
"It looks good," said Jones, the Assembly sponsor. "It’s been a battle, but this is the furthest it’s gone."
He said the need is clear. He said the task in negotiations in the Assembly is to persuade private-sector ambulances that they won’t lose revenue. But he admits that debate "is getting tougher."
"These ladies and gentlemen are doing bake sales on the weekends just to provide themselves with equipment to serve the public," Jones said in an interview with Newsday. "The bottom line is that in many areas of this state we don’t have enough emergency medical services to provide for our public and allowing this will help do that.
"I was in a meeting yesterday with local EMS people and we are going to be in a real crisis very soon," Jones said. "We just don’t have the volunteer service we had."