Why is LMRFD NOT charging for ambulance runs unless patients are transported?

This is the strangest thing.

LMRFD does NOT charge when the EMTs don’t transport the patient.

Is that crazy or what?

A friend called 911 because he was in terrible pain, but it got better while the EMT assisted him and calmed him down. He had nothing but praises for the EMT. The EMT didn’t take his insurance info. He’s on Medicare and has supplemental, surely they would have paid a few bucks for an ambulance to drive about 60 miles to assist him.

  • Board member Charlotte wants to use CREDIT CARDS in the ambulance to get payments.
  • Chief DeMaio refuses to bill for these ambulance runs.

One time the chief mentioned that the ambulance went from Dolan to Meadview to the same patient THREE times — not one cent was billed because they didn’t transport.

I really don’t want to see credit cards requested in the ambulance, but why not bill for services rendered?

I think what we need more than ANYTHING in Meadview is a traveling nurse, someone who cares about people and provides services right here.  Just like that EMT.

Why not hire an EMT / nurse to drive a little truck (not an ambulance) to make those house calls and s/he can call the helicopter if we need a transport?  This could be people being at home instead of at the fire station and you pay a monthly minimum and then per call.

Emergencies can FLY.

Ever wonder how many people die in Meadview every year because they’re afraid to call 911?

While locally known as “Beverly Hills”, many old poor people live in Meadview. They deserve better!

I heard that a man in his 80s got injured at the Family Dollar and he refused transport to the hospital because on a previous occasion he had to pay $300 for a cab to get back home!

36 Responses to Why is LMRFD NOT charging for ambulance runs unless patients are transported?

  1. Hi Christine,

    Actually, Charlotte Kiffer withdrew her suggestion regarding credit cards on the ambulance. Also, insurance companies won’t pay a cent for an ambulance call without transport. As required by Arizona Statute and long standing LMRFD policy, we always have billed the patient for calls where there was any hands on assessment, including BP checks (just the base rate, no mileage) . They were allowed one call per year without charge, and were allowed unlimited access to EMS assessments at the station without charge. There are some who abuse the ambulance service with repeated calls for service at home, and then refuse transport. The only way to discourage that abuse and to cover the cost of operating our ambulance service is to bill the patient for runs resulting in a refusal that insurance will not pay.

  2. Ellen, is all that explained on the LMRFD website somewhere? First I hear about that.

    Why the “freebie” and not bill insurance instead?

    Don’t know of anyone else providing freebies anywhere — whether a doctor or hospital, and they don’t even have to drive to see the patient! This is CRAZY!!!!

    What was the argument you had with the chief about then? I must have totally misunderstood.

    • It is explained on the website, as follows: “Arizona DHS/EMS has the following requirement:

      Should the patient come directly to the Fire Station and NOT Be transported, there will be NO charge.

      Should an ambulance be called to come to a residence or a scene and the patient(s) are NOT transported, the patient(s) will be billed for the base rate.”

      This statement is on the LMRFD website on the EMS page, and reflects the law and LMRFD policy for as long as I have heard of.

      Again, if the patient is NOT transported, the insurance companies will NOT pay, no matter how many miles the ambulance runs or how many times it runs to the same address.

      The one “freebie” a year was voted in by the previous Board, to allow for residents who come from other places and expect free curbside ambulance service, to learn and adjust. Some other places have ambulance service covered 100% by taxes. That’s why the taxes are so high in those places, and people move out here to get away from them. Our ambulance service is not covered 100% by taxes. It is subsidized by the taxpayers to a greater or lesser degree, depending upon how it is managed. Poor management=more tax money used. Good management=less tax money used.

      The statement by the chief in answer to a Board member’s question at the (Sept?) meeting that left a few of us with our mouths hanging open, wondering when LMRFD billing policy changed was, “It is illegal to bill for runs that result in a refusal, such as blood pressure checks, etc.” (Hopefully that statement will eventually be revealed in your video of the meeting.) It is essential that ALL runs be entered into the LMRFD reporting system with accurate and complete data reflecting whether there was ANY hands on assessment or treatment, including BP checks. The billing company will then bill appropriately. Sometimes that means billing the patient. Only the Board can change the LMRFD billing policy, by Resolution. It is not within the chief’s authority to decide which runs to enter into the system or how to enter the data, affecting how they are billed. That would be discrimination. It is the chief’s responsibility to the taxpayers to make “every effort to collect on every run”. The chief is responsible for proper training of EMS personnel doing reports, and the monitoring of reports to ensure that every call is entered with complete and accurate information. Monthly reconciliation of the number of runs reported by Kingman Dispatch to the number of runs reported within the LMRFD reporting system, for example, is one of the chief’s/admin’s duties that would expose runs not being entered for whatever reason. Unreported runs, and runs written off as “refusal” and not entered when they are actually billable, are lost revenue to the district and taxpayers are eventually called upon to cover the loss with tax rate increases. I am opposed to continually rising tax rates in all areas of government while those responsible for spending my tax dollars do so carelessly.

      • This really is complicated. One issue:

        “Again, if the patient is NOT transported, the insurance companies will NOT pay, no matter how many miles the ambulance runs or how many times it runs to the same address.”

        Around here it’s mostly Medicare and AHCCCS. If they don’t pay unless someone goes to the hospital, maybe patients DO have to get billed directly — something I really oppose.

        If people KNOW that, then they’re more likely go to the hospital and the insurance then pays for the ambulance AND hospital, doctors, etc.

        It is STUPID and a horrendous waste of money, but maybe that’s what it’ll have to be.

        How much is a typical run to Meadview billed for?

        And regarding the “freebie” — that’s really weird too. Is everybody supposed to get their freebie once a year like a when you get a coupon for a free coffee at Starbucks?

        Nobody should EVER worry about how to pay for an ambulance and especially when it’s at least an hour for someone to show up, how long should someone with symptoms of a heart attack or stroke wait before they call?

        Old people OFTEN don’t feel well and don’t know why. We really need a totally different system because THIS is not working and never will.

        • I don’t know if the one “freebie” a year is still policy or not. It may have been changed since 2013 when I was last aware of it. That policy due IN PART to a short term contract the LMRFD had with Hualapai Mtn. Hospital as its base hospital. The ambulance crews were required during that time to do an assessment on EVERY person they contacted, and could NOT take “NO” for an answer. That coercement made for a lot of uncollectable billings, which, according to LMRFD policy, required making “every effort to collect”. A total waste of time and energy when most were out of state, out of country, on the highway calls, and not wanted in the first place.

          You said, “Around here it’s mostly Medicare and AHCCCS. If they don’t pay unless someone goes to the hospital, maybe patients DO have to get billed directly — something I really oppose. If people KNOW that, then they’re more likely go to the hospital and the insurance then pays for the ambulance AND hospital, doctors, etc.”

          You hit the nail on the head. EDUCATION is absolutely necessary. If people KNOW they will be held responsible for the non transport ambulance call, then they will be more likely to go to the hospital. The ambulance should be reserved for EMERGENCIES. Especially when we have ONE crew to service 2200 square miles. The problem is, when there is ignorance, nebulous interpretations, and misinformation, such as, “IT IS ILLEGAL TO BILL FOR REFUSALS, SUCH AS BLOOD PRESSURE CHECKS, ETC.”, people don’t KNOW. The chief, admin and EMS personnel MUST get on the same page. They must clearly publish, verbalize, and follow the policies as established by the Board.

          As for your question regarding the cost of a typical run to Meadview, assuming the rates posted on the LMRFD website are up to date, with the base rate at $1797.48 and mileage at $14.62/mile, if it is approximately 60 miles to KRMC from Meadview going Stockton Hill Road, it would cost about $2600 – $2700.

          You said, “Old people OFTEN don’t feel well and don’t know why. We really need a totally different system because THIS is not working and never will.”

          AGREED! We are so lied to, manipulated, controlled and enslaved by the current system, with our very life energy sucked out of us for the enrichment of a few. We can only continue to do our best within our circle of influence, to enlighten, improve, and help where we can. When we choose to live in extremely rural areas we must expect less than perfect services. And, especially then, we must forge supportive relationships with neighbors to help each other. Government and government services are NOT the answer.

  3. Question, when you take your car into a mechanic to see what the problem is and you elect not to have repairs done do they charge you. When you go into a restaurant, are seated, have water brought to the table then decide there was nothing on the menu or it’s to expensive do they charge you. Are we paying the EMTs and firefighters to sit around and watch TV? It’s all part of the service provided by taxes. When they transport and taken out of service that is a different matter.

    What I would be more concerned with is why the EMTs can’t find the right location. Why are the deputies are not notified of an EMT call so they might get there quicker and render aid.

    When an accident happens with injuries
    the county might issue a ticket and collect monies from it. The fire district should also be able to submit a bill for services also.

  4. Totally agree with you for not charging for services NOT rendered. And anyone can go to the fire station and receive FREE services there, that’s great.

    What do you think would happen when you order a pizza and then you tell the delivery guy (after he drove 30 miles to get to your house) that you don’t want it anymore?

    What do you think would happen when you call a tow truck and they come from Kingman and you tell them that you don’t need them anymore because your car finally started?

    “Are we paying the EMTs and firefighters to sit around and watch TV? It’s all part of the service provided by taxes. When they transport and taken out of service that is a different matter.”

    You don’t seem to understand that when they drive to Meadview to assist someone who was in so much pain he called 911, they ARE taken out of service and someone else could die.

    It’s not about the lousy $12/hour the EMTs get. You seem to have no understanding of what it costs to run an ambulance, especially on what they call “roads” around here.

    At this time people in Meadview are DYING because it takes an hour (at best) for an ambulance to come up from Dolan.

    You don’t seem to be aware that only ONE guy is up at the Meadview fire station SOMETIMES. He cannot transport.

    Billing people who don’t have the money to pay is rather pointless — when was the last time you squeezed blood out of a rock? Ain’t happening!

    • Thank you Christine. You made a few points better than I could have. We have 2 guys on duty in Dolan, and sometimes a 3rd in Meadview, and the plan was for our chief to be a 4th, but with his meetings and whatnot…well, we generally have 2 guys covering 2200 square miles for both Fire and EMS calls. As long as they are “sitting around watching TV” they are available for taxpayers to come into the station to get checked out..BP checks, heart monitor, blood sugar test, etc….all day long. They are ready to roll for a life threatening call. Once they go to someone’s residence to do a BP check, etc., then, the station is locked up and they are gone, unavailable for anyone else wanting to get a BP check, etc. They would still receive the dispatch for a life threatening call, but responding from…where?

  5. Ok then let’s try this. We live on Long Island, N.Y. during the summer months. Nassau County is located next to Queens County, New York City. Nassau County has approx. 1.5 million population. You would think we would have above average paid fire and EMS there. We do but it’s not paid. There are 74 volunteer fire and EMS departments. The are 8 battalions with a central dispatch connected to the 911 system. Our area
    with approx. 6,000 residents has one primary ambulance and a back up. The ambulance will have 2 EMT 1 or 2 and a EMT 3 (tech) when they roll. But backing up. You call 911 for help and these are the steps. When received the 911 operator will transfer the call to Fire Comm (centralized dispatch for the 74 departments) the police dispatched operator is also on line. The police operator will dispatch one two man or 2
    one man car to the location. Each car has a AED and oxygen plus EMT 1 trained office. The volunteers are dispatched and if not available or do not respond in a timely manner a neighboring community ambulance is dispatched. The County Police also have one person (paramedic) ambulances that will be dispatched when need. The County Police helicopters are also medical air ambulances.

    The County charges for TRANSPORTED services either their ambulances or helicopters.

    The volunteer fire departments do no.

    We have a fire / EMS tax added to our property taxes.

    This system works and is affordable and SAVES lives.

    Bring the volunteers back to Meadview.

    • ” Nassau County has approx. 1.5 million population. ”

      Population density is key to successful volunteer anything. Statistics as recorded on city-data.com, show Meadview with a population of under 1500, and Dolan Springs under 2500. They both show a median age of around 65, with income considerably lower than state wide average. We are 50 – 60 miles from a town of any size. There is no comparison to high population, younger, high income areas and their historically successful volunteerism. Meadview’s successful volunteer fire/EMS force was due to an influx of 50 something retirees with knowledge and skills 30 some years ago. Definitely “bring the volunteers back to Meadview”! Bring them to Dolan Springs, too! How can we attract some younger, knowledgeable, skilled people with retirement incomes to come live out here and volunteer as firefighters and EMS personnel?

      • Ellen, there are more and more younger people living here. But most don’t have a CLUE about the fire district.

        Why isn’t Bobby a volunteer anymore?

        I think there are at least two major reasons why we have only one volunteer in Meadview:

        1) the physical requirements.

        Do you really care how far your EMT can run? I’d prefer the EMT DRIVE to my place!

        2) drug testing

        It’s crazy to drug test for marijuana while allowing fire fighters to be drunks!

        So many residents and especially the younger people have medical cards. And what’s wrong with that?

        My sister in Germany is very concerned with her daughter hooking up with one of those “drunks” in their volunteer fire department. Just like 40 years ago, they STILL spend a lot of time getting drunk at the local bars. They’re not EMTs, have nothing to do with ambulance. It’s a fun thing to do for the boys in small towns.

        I think we’re better off with mature adults.

        • Hi Christine,

          Unless something has changed in the last year or so, volunteer EMS personnel are not required to pass any physical tests.

          LMRFD Firefighter and EMS personnel, whether paid or volunteer, are not allowed to be under the influence of alcohol or drugs when on duty. That includes prescription drugs…anything that impairs a person’s ability to react quickly and make good judgment calls under extreme circumstances. If they show up for duty with any sign of being drug or alcohol impaired they would be sent home, at minimum, and possibly fired, depending on other factors. The FD liability insurance, which is a HUGE expense to the taxpayers, would be in danger of cancellation or skyrocketing premiums if drug and alcohol testing requirements weren’t met…for both paid employees as well as volunteers. Those are requirements established by Arizona Statute, Arizona Dept. of Health Services Bureau of EMS, and enforced by the LMRFD liability insurance company, VFIS.

          • “LMRFD Firefighter and EMS personnel, whether paid or volunteer, are not allowed to be under the influence of alcohol or drugs when on duty.”

            Of course. But that has nothing to do with that idiotic drug testing for marijuana.

              • What’s the question?

                You’ve never smoked weed? 😉

                In case you haven’t, you don’t go mad and jump out A 15th floor window or murder people.

                People feel better, are relaxed and happier.

                If you let people get DRUNK the night before they work, why can’t they get stoned?

                • Actually, I have tried it twice; once when I was 18 and once when I was 40 something. At 18 it did nothing, and I thought all the people sitting around saying, “Wow, man, this is some good shit!” were all pretending. I thought that was really stupid. At 40 something, after a few puffs, I lost a couple of hours of my life that I remember nothing of. That freaked me and I never messed with it again. At the very least, I can attest that it affects different people differently. I’ve seen a variety of affects on people other than myself, and they are not all benign. Additionally, the effects last longer than the those of alcohol and are more difficult to ascertain. I know I do not want anyone high on anything diagnosing or medicating me in any manner.

    • Randy, really appreciate that you are looking into response times, dispatch problems etc. and especially that you show up to the meetings and put those issues on the record.

      Please keep it up!

      And of course that also applies to Ellen, but I’m SO used to her always being there, I forget to mention that.

      • My pleasure. Stories I’ve heard and reasons why the Meadview and area do not have EMS and fire service are not acceptable. Some individuals have egos that have to be deflated and work toward a safer place to live and work.

        • Agreed! And, here’s an idea that one big ego thinks is foolishness, but then, he lives in a Fire District that AMR (American Medical Response) covers. AMR is the ambulance that backs us up when our crew is out. They actually turn a profit with their ambulance service while having adequate vehicles and personnel. They don’t want our C.O.N. because it isn’t profitable.

          Anyway, here’s an idea to consider:

          1. Seeing as how there are ever increasing fatal accidents at the junction of Hwy 93 and Pierce Ferry Road, due to tourist traffic traveling to the Skywalk, and,
          2. Seeing as how little or none of the revenue made from that tourist traffic benefits the LMRFD, or its residents, and,
          3. Seeing as how the taxpayers in the LMRFD are called upon to foot the bill for ambulance runs on out of country tourists that result in uncollectible billings,

          What about making Pierce Ferry Road a toll road? A few years when I asked into it, I learned that it was “impossible” because you cannot make an existing road into a toll road. But, if there is a change to the approach to the road, it can. The junction at Hwy 93 and Pierce Ferry Road is becoming a slaughterhouse with horrendous accidents resulting in multiple fatalities on a monthly and sometimes weekly basis.

          So, what about getting the local population together to demand our County Representatives pursue putting in an overpass at that junction for the traffic turning from the Southbound turn lane. It could be designed to be compatible with the eventual I-ll. Most importantly, it would save many lives while providing opportunity to make PF Rd. a toll road. According to some rough calculations based on 2013 visitor data to the Skywalk, it could bring in a half a million $$ every year, easily. If the LMRFD received even half of that it would increase the annual revenue by 50%. Of course, locals would be issued a free pass.

          All we need is some volunteers to head up a citizen’s group to push the issue.

  6. Ellen, I have been talking about an overpass for years, this intersection 93/PF is INSANE!

    1) I HATE toll roads with a passion — the fast lane for the rich and famous — let the little people WALK!

    The BOS kept saying that the roads are paid for with HURF funds, but Jean Bishop recently changed her tune.

    2) I can’t imagine that it would be profitable. Do you have any idea how much it would cost?

    How do you come up with half a million in profits?

    3) What’s going on with the sidewalks and third lane Dolan is going to get?

    I have not at all checked into this, haven’t seen a plan, budget, or anything. Do they plan to raise the speed limit then?

    I don’t understand WHY they don’t spend the money instead on a Dolan bypass, coming from Meadview, cut across to 93 from before the school.

    It’s really hard to figure out what the people of Dolan Springs want. Judging by Facebook, they HATE tourists with a passion and they LOVE the cows on the roads. But those are just the people on Facebook.

    Most likely, the majority of residents could not care less about LMRDF, the roads, the cows, etc. Most people have no interest and no clue.

    Have you contacted Jean Bishop for her input?

    • Christine, I think you are over reacting to the idea of a toll road. I’m not talking huge bucks, just $1.00 per person, and like I said, FREE PASSES FOR LOCALS.

      I hesitate to state the statistics that resulted in my statement that it could result in “half a million in profits”, because I don’t have the info in front of me and don’t have time right now to go digging for it. But off the top of my head, to the best of my recollection, it was in 2013 that a news report came out with Grand Canyon West touting 700,000 visitors to their world famous glass bridge. (That number has no doubt increased significantly by now. ) Even allowing for an unlikely large number of those flying in, say 29%, that leaves 71% (500,000) , passing through the LMRFD in buses and private vehicles up Pierce Ferry Road. At $1 per person, the conservative gross estimate would be $500,000/year.

      A toll road would be a minimal inconvenience, with the huge advantage being that those who most heavily use the road and local services would help pay for them. Many of us are weary of the solution to everything being “raise taxes”! Property owners are sitting ducks! They have to pay up or lose their homes. The easy fix of asking for a special property tax levy every time something breaks in the LMRFD precludes any creative, forward thinking or effort on the part of those in charge. Instead of crisis management let’s be proactive for a change and plan ahead. The handful of property tax payers in the LMRFD are not going to be able to indefinitely subsidize the entire I-11 and surrounding area with its growing commercial and tourism load.

      We NEED an overpass at Hwy 93 and Pierce Ferry Road. Let’s take advantage of the opportunity to make it a toll road and secure ongoing funding for our County Roads, Sheriff presence, as well as Fire and EMS services.

      • Something has to be done for sure but wishfull thinking that they will build a fly over or toll road is a waste of gray matter.

        Easy fixes would be to 1) Have the AZDOT lower the speed limit at 93 & PFR from 65 to 45. 2) install the flashing warning signs for traffic turning onto FOR. from 93 and FOR onto 93. There needs to be the flashing stop sign on both sides PFR at 93 and at the left island between the north and south bound 93. This was brought up to Bishop and all she had say it cost money that the county didn’t have. B’S 3) The county should get state approval to add a surcharge to every ticket issued by the sheriff on FOR and Stockton Hill. These funds will be used to hire and add a deputies to these roads.

        • Applying band-aids would lose a golden opportunity to provide a long term substantial revenue source for the LMRFD as well as the County.

            • The problem currently is that people don’t pay attention and don’t follow existing laws. Not sure more signs, lights and laws will change that.

              The thousands of $$ that would be spent putting up flashing signs, etc., could be put toward the long term solution of an overpass. It could be designed to interface with the I-11 when/if it happens.

              Last I looked into it, just the approach to an existing road needs to change in order for it to be eligible as a toll road, not the entire road.

              The State and or County would pay for the overpass initially. The toll collected would repay that and provide ongoing revenue for maintenance of Pierce Ferry Road, a Sheriff’s presence, and EMS services. It is the ONLY way that those who most heavily use those services will help support them.

              I don’t have the facts and data to provide a detailed analysis. It seems feasible enough to warrant some investigation and honest evaluation by someone who DOES.

    • Please, this issue has been driven into the ground. I for one think the community really needs to address other subjects that affect our health and welfare. One, the board needs to start looking at a combination department with paid and volunteers. Bet if you put the question out about a volunteer EMS service 10’s of residence including me would sign up. From what I have heard repeatedly is there was a good volunteer EMS and fire department in Meadview. One person proposed the current change for his benefit and DESTROYED the services that worked here. Now look what we have ZERO, ZIPPO NOTHING and no one is being held accountable. Where is the money going, who is in charge and where does the buck stop. The current board should be ashamed at the lack of leadership they are projecting and expect from the fire district if that’s what they continue to call itself. I have other names for it

  7. Randy, what am I missing? Community paramedics are EXACTLY what we need! And if people want to volunteer for that, even better.

    Why don’t you want care for the people here? This is how we can get enough BUSINESS up here in Meadview to be able to pay for the real healthcare we so desperately need.

    Elections are coming up and I will DEMAND that our state reps get their asses off their lounge chairs and finally do some REAL work and tell us how to get separated from Dolan. Work together, reciprocate, but ensure we have coverage up here.

    THEN people will volunteer AND join the district.

    • Dah.. that’s what I was getting at. Bring the volunteers back, under the command of the “current” chief and commission. There should be a person of rank overseeing the vols that reports to the chief and APPOINTED BY THE VOLS. The vols would perform basic life support BLS and transportation and the district advance life support ALS. When there is a dual response the ALS personal are in charge. When a non life threatening incident occurs with both BLS and ALS respond the BLS will transport so the ALS cans go back into service.

  8. The current chief has absolutely NO time to oversee anything. And doesn’t live here, NEVER lived here. About half a year ago I requested a listing of calls to Meadview with the results and I’m STILL waiting.

    I’d rather pay a couple thousand to a local “chief” who deals ONLY with medical issues. We don’t need a fire department, as Bobby explained so well at the last meeting.

    Volunteers are great, buy why shouldn’t qualified professionals get paid?

  9. With What? Most of the residents are on fixed incomes living month to month paid days. So where do you suggest they get the money to pay for the same BS service they get now? The County doesn’t care, the district doesn’t, the state doesn’t and the residence don’t care until they need it.

  10. There are MANY options. Take another look at this article:
    http://directorsblog.health.azdhs.gov/whats-community-paramedicine/

    “… For example- paramedics could shift from a sole focus on emergency response to things like: 1) providing follow-up care for folks recently discharged from the hospital to prevent unnecessary readmissions; 2) providing community-based support for people with diabetes, asthma, congestive heart failure, or multiple chronic conditions; and/or 3) partnering with community health workers and primary care providers in underserved areas to provide preventive care. …”

    This was in 2013 and there should be lots more info available by now. Also please note that this is from the official Arizona Department of Health Services director.

    If paramedics could perform all these services here, they’d be BUSY! And, they’d get paid by INSURANCE.

    And if we separated from LMRFD, we could form a new district and everybody would pay their share. But, we really don’t need a fire district, we need healthcare.

  11. My comment at the DHS blog:

    Your comment is awaiting moderation.

    We are in an extremely underserved rural area (Meadview) and I would really appreciate more information. Too many seniors are suffering and dying because it takes at least an hour for an ambulance to take them to the nearest hospital in Kingman (60 miles.)

    Some people are so poor, they refuse the ambulance rides because they can’t afford the $300 cab ride back home. Others constantly call 911 and then are not transported. We need a local traveling nurse to visit seniors (many with serious Alzheimers / dementia) in their homes.

    Thanks!

    —————————————

    Maybe I’ll get a reply.

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