No more free ambulance rides in Edmonds, Lynnwood

Published 11:44 pm Saturday, April 11, 2009

The days of local free ambulance rides are over — sort of.

The last two fire departments in Snohomish County that have been offering no-cost rides — the Edmonds and Lynnwood fire departments — have started sending bills to patients’ insurance companies. Other county departments have been doing that for nearly 30 years.

Ambulance fees in the two cities can cost $800 plus mileage for victims of heart attacks and other serious trauma. The fees help pay for a vital service that tax dollars don’t completely fund, officials said.

In Edmonds and Lynnwood, however, collection policies could leave nearly $1 million owed to the public unpaid in 2009.

Those cities aren’t the only ones facing unpaid ambulance bills. In most departments in Snoho­mish County, people who refuse to pay, despite repeated letters and phone calls, often don’t face any consequences.

There are exceptions. Marysville and Mukilteo have been chasing after overdue bills for years, and Everett started this year after a 2006 state auditor report recommended the city stiffen its back.

In 2008, Everett failed to collect $1.5 million of the $2.8 million it billed for ambulance services. Much of that money was left over after insurance companies made partial payments.

Since the start of the year, people who do not live or work in Everett could be facing bill collectors if they don’t pay what they owe to the city’s fire department. The rules are different for people who live or work in Everett whose insurance payments are judged sufficient.

“We have to be responsible for the service that we are providing, and ensure that we are not subsidizing those who just refuse to pay,” said Everett Fire Chief Murray Gordon. The city recently sent 12 patients to a collection agency, he said.

Marysville Fire Chief Greg Corn said his department believes not sending debtors to collection agencies is the same as handing people a gift of public funds.

Still, few fire departments in Snohomish County follow Marysville’s example.

Edmonds’ new ambulance fee is expected to raise $700,000 in 2009, all of it from insurance companies. That is only half of the $1.4 million the city is on pace to bill. The shortfall is mostly money that is above what private insurance, Medicare or Medicaid will pay.

The city could theoretically pursue the rest of the bills, but a city policy doesn’t allow the fire department to do that.

“Our goal is not to squeeze somebody who is already in tough times,” said D.J. Wilson, Edmonds City Council president. The city will chase insurance dollars from insurance companies, but pursuing money owed by people “is a totally different scenario,” he said.

Independent fire districts can make their own debt-collection decisions, according to opinions from both the state Attorney General’s Office and the federal Office of the Inspector General.

It is still a costly choice in a place like Edmonds, where a $1 million revenue shortfall is prompting furloughs at City Hall and other cutbacks include closing the city’s popular public pool.

Still, not sending aggressive collectors after taxpayers could be a strategic decision, officials said.

Chasing ambulance fees could be “very detrimental” to passing any new emergency medical service levies, which bring in millions of dollars to fire departments, Edmonds City Councilman Ron Wambolt said.

Others in government say the decision is about compassion.

Gordon, the Everett fire chief, calls policies that forgive fees the “sensitive side of government, the benevolent side of government.”

In every aspect of health care, there are patients — uninsured or otherwise — who simply cannot afford to pay the bills they have incurred, he said. Those debts are considered charity care or bad debt. In many cases, they are forgiven.

Forgiving debts can make financial sense, said Greg Macke, the assistant fire chief in Lynnwood. Since the city began charging for ambulance rides Feb. 26, officials have billed $156,000. No money has been collected yet, because payment processing takes time, city officials said.

Big collection expenses don’t make sense for Lynnwood now or in the future, Macke said.

“People don’t want us to run up huge bills with their tax dollars to go after $100,” said Macke, who compared the bills to unpaid traffic or parking tickets.

Private ambulance services look at the issue differently.

They provide backup when public departments are busy. Customers who don’t pay will be pursued, said Mike Collins, general manager of the privately operated ­Rural-Metro Ambulance’s Snohomish County office.

“We are like any other company that somebody might owe money to,” Collins said.

Another part of the problem is that local departments deal with hundreds of calls every year where an ambulance is not actually needed. These can turn ambulances into expensive taxis for people with minor ailments such as sprains or colds, or for people who are simply lonely.

Researchers at the University of Wisconsin found in 2006 that approximately 18 percent of ambulance users do not need urgent care.

There is more to be gained from solving ambulance abuse than there is in sending past-due bills to collection, said Lynn­wood’s Macke. A free taxi voucher program and other ideas are being considered to handle patients who might otherwise misuse department resources, he said.

Doing the job is the most important thing for everyone, Edmonds Fire Chief Tom Tomberg said. So far, people in his city haven’t complained about the new fees, because ambulances continue to show up when they’re called.

“When people are ill or injured, I don’t think they focus on anything other than being assisted as quickly and expeditiously as possible to the nearest hospital,” Tomberg said. “(The fee) has been a nonissue so far.”

Chris Fyall: 425-339-3447, cfyall@heraldnet.com.